Turkish Neurosurgery
The Efficacy of Indocyanine Green Video Angiography during Carotid Endarterectomy: An Institutional Experience
Melih Bozkurt3, Eroglu Umit 1, Eyup Bayatli1, Murat Zaimoglu1, Mahmut Ozden3, Tarek El Ahmadieh4, Aaron A Cohen-Gadol5, Basak Ceyda Meco2
1Ankara Universty Faculty of Medicine, Neurosurgery, ankara,
2Ankara Universty Faculty of Medicine, Anesthesiology and Reanimation, Ankara,
3Memorial Bahçelievler Hospital, Neurosurgery, Istanbul,
4Memorial Sloan Kettering Cancer Center, Neurosurgery, New York,
5Indiana University, Neurosurgery, Indiana,
DOI: 10.5137/1019-5149.JTN.41368-22.2

Aim:Indocyanine green video angiography (ICG-VA) effortlessly and immediately allows vascular structures imagination during micro-neurosurgical operations. In this study, we present our experience of 44 consecutive carotid endarterectomy procedures in 42 patients and assess the efficacy and success of ICG-VA in the localization of the plaque sites, extent of the arteriotomy, evaluation of the flow, and presence of thrombus after closure.Material and Methods:This study was retrospectively designed, which included all the patients who underwent carotid stenosis operation between 2015 and 2019. ICG-VA was used in all procedures, and patients with available follow-up and full medical data were analyzed. Results:Forty-two consecutive patients who underwent a total of 44 CEAs were included. The population consisted of 5 (11.9%) female and 37 (88.1%) male patients, all of whom had at least 60% carotid stenosis, as assessed using North American Symptomatic Carotid Endarterectomy Trial stenosis ratios. The mean stenosis rate was 80.55% (range, 60%–90%), the mean patient age was 69.8 years (range, 44–88 years), and the mean follow-up duration was 40 months (range, 2–106 months). In 31 (70.5%) of 44 procedures, ICG-VA revealed the exact location of the obstructive plaque’s distal end, and it successfully showed the arteriotomy length, identifying the location of the plaque. ICG-VA correctly evaluated the flow in 38 (86.4%) of 44 procedures.Conclusion:Our reported study is cross-sectional, reflecting our experiment using ICG during CEA. ICG-VA can be used as a simple, practical, real-time microscope-integrated technique that can enhance the safety and effectiveness of CEA.

Corresponding author : Eroglu Umit