Usefulness of intraoperative Indocyanine green video angiography to select the recipient artery for bypass surgery in arteriosclerotic occlusion of the middle cerebral artery: a technical case report

Area of Science:

• Neurosurgery
• Vascular Surgery
• Neurology

Background:

• Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass surgery commonly uses indocyanine green video angiography (ICG-VA) to confirm bypass patency.
• The use of ICG-VA to evaluate recipient vessels based on collateral flow or distal branch identification is less frequently reported.

Observation:

• A case involving an 82-year-old man with progressive cerebral infarction due to right middle cerebral artery M2 inferior trunk infarction.
• During STA-MCA bypass surgery, M4 cortical arteries fed by the inferior trunk were not identifiable as recipient arteries.
• Intraoperative ICG-VA revealed delayed luminescence in certain M4 arteries.

Findings:

• The delayed luminescence observed with ICG-VA correlated with delayed retrograde flows from the anterior cerebral artery, as seen on preoperative digital subtraction angiography.
• These M4 arteries with delayed luminescence were identified as being supplied by the inferior trunk and were selected as recipient arteries.

Implications:

• ICG-VA demonstrates variations in flow speed through delayed luminescence.
• This characteristic of ICG-VA can be a valuable tool for identifying appropriate target vessels in complex bypass surgeries.
• This technique enhances the precision of recipient vessel selection in cerebrovascular reconstructive surgery.