Intraoperative blood flow monitor for aneurysm clipping: A comparison between Flowmetry and Indocyanine Green videoangiography
Background: Both indocyanine green videoangiography (ICG-VA) and flowmetry were considered beneficial in preventing parent artery compromise during aneurysm surgery. However, the appropriate strategy that should be used remains controversial. The objective of the study is to assess the outcomes of a...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health/LWW
2022-01-01
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| Series: | Formosan Journal of Surgery |
| Subjects: | |
| Online Access: | http://www.e-fjs.org/article.asp?issn=1682-606X;year=2022;volume=55;issue=6;spage=207;epage=214;aulast=Chen |
| _version_ | 1797705172038713344 |
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| author | Li Chun David Chen Shiu-Jau Chen |
| author_facet | Li Chun David Chen Shiu-Jau Chen |
| author_sort | Li Chun David Chen |
| collection | DOAJ |
| description | Background: Both indocyanine green videoangiography (ICG-VA) and flowmetry were considered beneficial in preventing parent artery compromise during aneurysm surgery. However, the appropriate strategy that should be used remains controversial. The objective of the study is to assess the outcomes of aneurysm clipping through flowmetry or ICG-VA monitoring.
Materials and Methods: This retrospective cohort study included 75 patients who underwent aneurysm clipping with vascular patency monitoring. In total, 42 patients underwent flowmetry monitoring and 33 ICG-VA monitoring. Preoperative disease severity and functional outcomes were assessed using the World Federation of Neurosurgical Societies (WFNS) grading system and the modified Rankin scale, respectively.
Results: As compared with ICG-VA, flowmetry group had nonsignificant higher incidence of clip modification (31.7% vs. 18.2%, P = 0.29) and residual neck (22% vs. 10%, P = 0.218). Besides Fisher grade, flowmetry monitoring (Crude odds ratio [OR] = 0124, P = 0.015), young age, and anterior communicating artery location were the independent risk factors for vasospasm based on multivariate analysis. The incidence of parent artery compromise did not differ between both groups. Old age, poor preoperative WFNS grade, low Glasgow coma scale (GCS) score, left-side location, and long hospital stay were associated with poor functional outcomes in the univariate analysis. However, only the GCS score was considered a prognostic factor in the multivariate analysis (Adjusted OR = 0.03, P = 0.034).
Conclusion: Both monitoring methods have similar functional outcomes. Although not influencing outcome, the flowmetry group has a higher incidence of angiographic vasospasm than the ICG-VA group. The vessel preparation for flowmetry monitoring is more complicated than that for ICG-VA; thus, we recommend ICG-VA for routine monitoring. Flowmetry may be applicable in distal aneurysms when hemodynamic insufficiency in a parent artery is suspected. |
| first_indexed | 2024-03-12T05:32:12Z |
| format | Article |
| id | doaj.art-1cb389aed9ed45fd9a3c27776bb12f85 |
| institution | Directory Open Access Journal |
| issn | 1682-606X |
| language | English |
| last_indexed | 2024-03-12T05:32:12Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Formosan Journal of Surgery |
| spelling | doaj.art-1cb389aed9ed45fd9a3c27776bb12f852023-09-03T06:42:50ZengWolters Kluwer Health/LWWFormosan Journal of Surgery1682-606X2022-01-0155620721410.4103/fjs.fjs_237_21Intraoperative blood flow monitor for aneurysm clipping: A comparison between Flowmetry and Indocyanine Green videoangiographyLi Chun David ChenShiu-Jau ChenBackground: Both indocyanine green videoangiography (ICG-VA) and flowmetry were considered beneficial in preventing parent artery compromise during aneurysm surgery. However, the appropriate strategy that should be used remains controversial. The objective of the study is to assess the outcomes of aneurysm clipping through flowmetry or ICG-VA monitoring. Materials and Methods: This retrospective cohort study included 75 patients who underwent aneurysm clipping with vascular patency monitoring. In total, 42 patients underwent flowmetry monitoring and 33 ICG-VA monitoring. Preoperative disease severity and functional outcomes were assessed using the World Federation of Neurosurgical Societies (WFNS) grading system and the modified Rankin scale, respectively. Results: As compared with ICG-VA, flowmetry group had nonsignificant higher incidence of clip modification (31.7% vs. 18.2%, P = 0.29) and residual neck (22% vs. 10%, P = 0.218). Besides Fisher grade, flowmetry monitoring (Crude odds ratio [OR] = 0124, P = 0.015), young age, and anterior communicating artery location were the independent risk factors for vasospasm based on multivariate analysis. The incidence of parent artery compromise did not differ between both groups. Old age, poor preoperative WFNS grade, low Glasgow coma scale (GCS) score, left-side location, and long hospital stay were associated with poor functional outcomes in the univariate analysis. However, only the GCS score was considered a prognostic factor in the multivariate analysis (Adjusted OR = 0.03, P = 0.034). Conclusion: Both monitoring methods have similar functional outcomes. Although not influencing outcome, the flowmetry group has a higher incidence of angiographic vasospasm than the ICG-VA group. The vessel preparation for flowmetry monitoring is more complicated than that for ICG-VA; thus, we recommend ICG-VA for routine monitoring. Flowmetry may be applicable in distal aneurysms when hemodynamic insufficiency in a parent artery is suspected.http://www.e-fjs.org/article.asp?issn=1682-606X;year=2022;volume=55;issue=6;spage=207;epage=214;aulast=Chencerebral aneurysmangiographyclippingflowmetryindocyanine green videoangiographyresidual aneurysmsubarachnoid hemorrhagevasospasmworld federation of neurosurgical societies gradefluorescence image |
| spellingShingle | Li Chun David Chen Shiu-Jau Chen Intraoperative blood flow monitor for aneurysm clipping: A comparison between Flowmetry and Indocyanine Green videoangiography Formosan Journal of Surgery cerebral aneurysm angiography clipping flowmetry indocyanine green videoangiography residual aneurysm subarachnoid hemorrhage vasospasm world federation of neurosurgical societies grade fluorescence image |
| title | Intraoperative blood flow monitor for aneurysm clipping: A comparison between Flowmetry and Indocyanine Green videoangiography |
| title_full | Intraoperative blood flow monitor for aneurysm clipping: A comparison between Flowmetry and Indocyanine Green videoangiography |
| title_fullStr | Intraoperative blood flow monitor for aneurysm clipping: A comparison between Flowmetry and Indocyanine Green videoangiography |
| title_full_unstemmed | Intraoperative blood flow monitor for aneurysm clipping: A comparison between Flowmetry and Indocyanine Green videoangiography |
| title_short | Intraoperative blood flow monitor for aneurysm clipping: A comparison between Flowmetry and Indocyanine Green videoangiography |
| title_sort | intraoperative blood flow monitor for aneurysm clipping a comparison between flowmetry and indocyanine green videoangiography |
| topic | cerebral aneurysm angiography clipping flowmetry indocyanine green videoangiography residual aneurysm subarachnoid hemorrhage vasospasm world federation of neurosurgical societies grade fluorescence image |
| url | http://www.e-fjs.org/article.asp?issn=1682-606X;year=2022;volume=55;issue=6;spage=207;epage=214;aulast=Chen |
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