Introduction: Intraoperative vessel imaging in cerebrovascular neurosurgery can drive the repositioning or addition of aneurysm clips prior to closure. After the introduction of indocyanine green video angiography (ICGA), our institution switched from routine intraoperative digital subtraction angiography (DSA) to routine ICGA. We sought to identify if the rates of perioperative stroke, unexpected postoperative aneurysm neck remnant, or parent vessel stenosis differed in the two eras.
Methods: We retrospectively identified the first 100 patients treated via open microsurgical aneurysm clipping in the years 2002 (“DSA Era”) and 2007 (“ICG Era”) at our institution and assessed rates of perioperative stroke, aneurysm remnant, parent vessel occlusion, patient cost, and technical difficulties and complications using each modality.
Results: In the DSA era, 81% of patients underwent intraoperative DSA; in the ICG era, 79% of patients underwent ICGA, and 13% of patients underwent intraoperative DSA. No study-related complications were noted in either era. The total clip repositioning rate for neck residual or parent vessel stenosis was not significantly different between the two eras (6% in the DSA era and 4% in the ICG era). There were no differences in the rate of perioperative stroke (4% in the DSA era and 3% in the ICG era) or rate of false-negative studies (1% in each). The per-patient cost of intraoperative imaging within the DSA era was significantly higher than in the ICG era ($13,617 vs. $2,186).
Conclusions: The replacement of routine intraoperative DSA with ICGA and selective intraoperative DSA in cerebrovascular aneurysm surgery is safe and effective.
Patient Care: Via propagation of ICGA as a safe and effective tool for the verification of successful aneurysm clipping
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of ICG angiography in aneurysm surgery, 2) Discuss, in small groups, the pros and cons of ICGA and DSA, 3) Identify an effective treatment paradigm for the use of intraoperative angiography methods "