Visualization of declamping procedure during carotid endarterectomy by ICG videoangiography.
BACKGROUND
ICG videoangiography (ICG-VAG) is widely used in neurovascular surgery. In carotid artery disease, it has been used to assess the extent of the plaque and to confirm the removal of the plaque and patency of the artery. We introduce a novel usage of the ICG-VAG to confirm the patency of the external carotid artery (ECA) and superior thyroid artery (STA), which should work as a drainage system of possible debris in the lumen.


METHOD
Consecutive 27 patients with severe internal carotid artery stenosis were employed. Carotid endarterectomy (CEA) was done in the usual fashion. After suturing the arteriotomy, ICG was injected intravenously before reperfusion. Before declamping procedure, ICG-VAG mode was started. As the declamping procedure went on, the assistant judged whether the STA and the ECA were patent by watching the ICG flow on the monitor. After confirming the patency of the ECA-CCA system, the ICA was reperfused.


RESULT
The back flow from the STA was not confirmed in two cases. The back flow from the ECA was confirmed in all 27 cases. In four cases, the ICG-VAG showed air bubbles in the lumen; these bubbles were washed away to the ECA or STA.


CONCLUSION
Using ICG-VAG during the reperfusion procedure of CEA, the patency of the ECA and the STA can be confirmed. It may contribute to reduce embolic complication during reperfusion procedure.
['Kimura|Toshikazu|T|', 'Kidani|Naoya|N|', 'Ibayashi|Kenji|K|', 'Kawai|Kensuke|K|']
D000328:Adult D002342:Carotid Artery, External D016893:Carotid Stenosis D002533:Cerebral Angiography D002536:Cerebral Arteries D015331:Cohort Studies D004396:Coloring Agents D003250:Constriction D004322:Drainage D016894:Endarterectomy, Carotid D005260:Female D006801:Humans D007208:Indocyanine Green D020766:Intracranial Embolism D008297:Male D008875:Middle Aged D011183:Postoperative Complications D014741:Video Recording
carotid endarterectomy ICG videoangiography embolic complication