Assessment of hemodynamic changes and hyperperfusion risk following extracranial-to-intracranial bypass surgery using intraoperative indocyanine green-based flow analysis.

Assessment of hemodynamic changes and hyperperfusion risk following extracranial-to-intracranial bypass surgery using intraoperative indocyanine green-based flow analysis.

World Neurosurg. 2018 Apr 04;:

Authors: Rennert RC, Strickland BA, Ravina K, Bakhsheshian J, Russin JJ

Abstract
BACKGROUND: Intra-operative blood flow assessments during cerebral bypass would ideally assess vessel patency, downstream perfusion, and risk of post-operative hyperperfusion syndrome (HPS). Previous studies using Indocyanine Green-based flow analyses (ICG-BFA) have identified multiple parameters that can intra-operatively track bypass-related changes in cerebral perfusion and potentially predict post-operative HPS risk. Herein, we determine the most robust parameter and anatomic location for intra-operative ICG-BFA assessment of bypass-related perfusion changes and prediction of post-operative HPS risk.
METHODS: Retrospective analysis of an IRB-approved prospective database identified patients undergoing superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. Demographic and clinical information, as well as manually calculated and automated pre- and post-bypass intra-operative ICG-BFA data from cortical, arterial, and venous regions of interest (ROIs) were recorded and analyzed.
RESULTS: Seven patients underwent STA-MCA bypass (4 Moyamoya, 3 carotid occlusions). Average age was 48.2±13.9 years (3 females, 4 males). While all parameters measured showed trends toward improvement post-bypass, only changes in arterial and venous automated ICG-BFA slope (also known as blood flow index [BFI: maximum intensity/rise time]) reached significance. 0 out of 7 patients experienced symptomatic HPS, despite 5 of 7 (71.4%) having an increased HPS risk based on previously published ICG-BFA data.
CONCLUSION: ICG-BFA has utility for the intra-operative assessment of bypass-related changes in cerebral perfusion, with automated BFI being the most robustly affected parameter. Although previously published ICG-BFA indices did not predict development of symptomatic post-operative HPS, larger-scale studies correlating observed ICG-BFA changes with HPS risk are warranted.

PMID: 29626683 [PubMed - as supplied by publisher]

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