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  • Microdoppler Ultrasonography versus ICG-VA to Control the Flow of the Parent Artery After Clipping

    Final Number:
    475

    Authors:
    Melih Bozkurt MD; Gokmen Kahilogullari MD, PhD; Onur Ozgural; Umit Eroglu; Ihsan Dogan MD; Sukru Caglar; Nihat Egemen MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Indocynanine green video angiography (ICG-VA) is a well-known tool in neurosurgical vascular procedures. Likewise microdoppler ultrasonography(MDUS) is another tool for evaluating the flow in the artery. We present our experience of ICG-VA and MDUS in 123 clipped aneurysms with regard to the flow in the distal parent artery.

    Methods: This study was made in the Department of Neurosurgery, University of Ankara on 123 aneurysms between July 2012 and July 2013. Single surgeon from 2012 performed each operation. In all cases, aneurysm neck remnant and vessel patency was controlled by ICG-VA and MDUS. All cases were controlled by postoperative angiography.

    Results: Of the 123 aneurysms clipped, 51(41%) were located in the anterior communicating artery (AComA), 48(39%) were located in the bifurcation of middle cerebral artery (MCA) and branches, 23(18.6%) were located in the internal cerebral artery (16 PComA, 7 ophtalmic artery) and one ((0.8%) was located at the basillary tip. ICG-VA used in all cases with MDUS. 4 (3.2%) of the aneurysms (2 ophtalmic artery,1 PComA and 1 AComA) parent artery occlusion was noticed during the MDUS examination. The occlusions were on the distal ICA in PCom and Ophtalmic artery cases and on the contralateral A2 in the AcomA case. All in the 4 cases ICG-VA revealed flow in the distal parent artery. Clip replacement was done in all 4 cases and flow was regained.

    Conclusions: Although ICG-VA is a well-established system to check the residual aneurysm and parent artery occlusion; it is inadequate to determine the flow in the distal parent artery and should give false-positive results. It should be as a consequence of residual intravasal activity or insufficient flow in the artery. MDUS is superior for determining the flow in the parent artery rather than ICG-VA.

    Patient Care: Decrease the incidence of surgical complications and increase the surgical outcome after clipping

    Learning Objectives: Microdoppler Ultrasonography versus ICG-VA to control the flow of the parent artery after clipping

    References:

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