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Postoperative hyperperfusion may lead to severe neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. However, there are no reliable modalities to predict the occurrence of postoperative hyperperfusion during surgery. The purpose of this study is to evaluate whether a semiquantitative analysis of indocyanine green (ICG) videoangiography could be useful in predicting postoperative hyperperfusion after STA-MCA anastomosis. This study included seven patients who underwent STA-MCA anastomosis due to occlusive carotid artery diseases. During surgery, ICG videoangiography was performed before and after bypass procedures, and ICG intensity-time curves were semiquantitatively analyzed to evaluate hemodynamic changes by calculating maximum intensity, time to peak (TTP), and blood flow index (BFI). Maximum intensity significantly increased from 252.6 ± 132.5 to 351.7 ± 151.9 after bypass (p < 0.001). TTP was significantly shortened from 12.9 ± 4.4 s to 9.8 ± 3.7 s (p < 0.001). Furthermore, BFI significantly increased from 33.9 ± 28.1 to 74.6 ± 88.4 (p < 0.05). Postoperative hyperperfusion was observed in five of seven patients 1 day after surgery. The ratio of BFI before and after bypass procedures was significantly higher in patients with postoperative hyperperfusion than those without, 2.5 ± 1.1 and 1.5 ± 0.4, respectively (p = 0.013). These findings suggest that semiquantitative analysis of ICG videoangiography is helpful in predicting occurrence of hyperperfusion after STA-MCA anastomosis in patients with occlusive carotid artery diseases.


Haruto Uchino, Toshitaka Nakamura, Kiyohiro Houkin, Jun-ichi Murata, Hisatoshi Saito, Satoshi Kuroda. Semiquantitative analysis of indocyanine green videoangiography for cortical perfusion assessment in superficial temporal artery to middle cerebral artery anastomosis. Acta neurochirurgica. 2013 Apr;155(4):599-605

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PMID: 23287901

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