title: Combined use of intraoperative indocyanine green and dynamic angiography in rotational vertebral artery occlusion.
abstract: Rotational vertebral artery occlusion, also known as bow hunter's syndrome, is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. The authors sought to determine whether intraoperative indocyanine green (ICG) angiography could reliably assess the adequacy of surgical decompression of the vertebral artery (VA). The authors report two patients who presented with multiple transient episodes of syncope provoked by turning their head to the right. Rotational dynamic angiography revealed a dominant VA that became occluded with head rotation to the right side. The patients underwent successful surgical decompression of the VA via an anterior cervical approach. Intraoperative ICG angiography demonstrated patency of the VA with head rotation. This was further confirmed by intraoperative dynamic catheter angiography. To our knowledge, we present the first two cases of the use of ICG combined with intraoperative dynamic rotational angiography to document the adequacy of surgical decompression of the VA in a patient with rotational vertebral artery occlusion. Intraoperative ICG angiography is a useful adjunct and may potentially supplant the need for intraoperative catheter angiography.
authors.affiliation: University of Illinois Hospital & Health Sciences System, Department of Neurosurgery, Chicago, IL, USA.
authors.forename: Nauman S
authors.initials: NS
authors.lastname: Chaudhry
authors.affiliation: University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, FL, USA.
authors.forename: Sudheer
authors.initials: S
authors.lastname: Ambekar
authors.affiliation: University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, FL, USA.
authors.forename: Mohamed Samy
authors.initials: MS
authors.lastname: Elhammady
authors.affiliation: Emory University School of Medicine, Emory Faculty Office Building, 49 Jesse Hill Drive SE, #341, Atlanta, GA 30303, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Riley
authors.affiliation: Emory University School of Medicine, Emory Faculty Office Building, 49 Jesse Hill Drive SE, #341, Atlanta, GA 30303, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pradilla
authors.affiliation: Department of Neurological Surgery and Neurology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: Emory University School of Medicine, Emory Faculty Office Building, 49 Jesse Hill Drive SE, #341, Atlanta, GA 30303, USA. Electronic address: faiz.ahmad@emory.edu.
authors.forename: Faiz U
authors.initials: FU
authors.lastname: Ahmad
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage*; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods; D008297:Male; D008875:Middle Aged; D012399:Rotation / Q000009:adverse effects*; D014711:Vertebral Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery
chemical_list: D007208:Indocyanine Green
keywords: Bow hunter’s syndrome; Dynamic angiography; Indocyanine green video angiography; Rotation vertebral artery occlusion; Vertebral artery