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Microsurgical Creation of Giant Bifurcation Aneurysms in Rabbits for the Evaluation of Endovascular Devices
Published on: September 8, 2023
Is an angiographically obliterated aneurysm always secure?
Francisco J Mery1, Sepideh Amin-Hanjani, Fady T Charbel
1Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Neurosurgery
|May 23, 2008
Summary
Intraoperative indocyanine green (ICG) video angiography may falsely indicate successful aneurysm obliteration. Careful dome inspection and potential long-term follow-up are crucial, even after seemingly secure clipping, to prevent aneurysm growth or rupture.
Area of Science:
- Neurosurgery
- Vascular Imaging
- Cerebrovascular Disease
Background:
- Conventional cerebral angiography is the standard for confirming aneurysm obliteration.
- Intraoperative indocyanine green (ICG) video angiography offers comparable real-time assessment.
- Complex aneurysms pose challenges for direct clipping and accurate imaging.
Purpose of the Study:
- To evaluate the reliability of ICG video angiography in confirming aneurysm obliteration.
- To highlight potential limitations of intraoperative imaging in neurovascular procedures.
- To underscore the importance of verifying complete aneurysm exclusion.
Main Methods:
- Case report of two patients undergoing direct clipping of unruptured aneurysms.
- Intraoperative ICG video angiography performed to assess obliteration.
- Aneurysm dome incision to directly visualize for dye extravasation.
Main Results:
- ICG video angiography falsely indicated complete obliteration in both patients.
- Dye extravasation was observed upon incising the aneurysm dome.
- Causes included incomplete clipping of wide necks and atheroma impeding clip closure.
Conclusions:
- Intraoperative ICG video angiography can provide a false sense of security regarding aneurysm obliteration.
- Limitations may extend to catheter angiography, necessitating caution.
- Long-term angiographic follow-up is advised when complete exclusion certainty is lacking.
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