Takahiro Shikayama

Intraoperative EC-IC Bypass Blood Flow Assessment With Indocyanine Green Angiography in Moyamoya and Non-Moyamoya Ischemic Stroke

OBJECTIVE Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis has been used in moyamoya disease (MD) and non-moyamoya ischemic stroke (non-MD). It is important to monitor hemodynamic changes caused by bypass surgery for postoperative management. We evaluated the bypass blood flow during STA-MCA anastomosis by using indocyanine green (ICG) fluorescence angiography. METHODS We evaluated the bypass blood flow in 13 MD and 21 non-MD patients during STA-MCA anastomosis by means of ICG angiography with injection of ICG into the anastomosed STA. The ICG perfusion area was calculated when the ICG fluorescence intensity reached maximum. We measured cortical oxygen saturation before anastomosis by means of visual light spectroscopy. RESULTS ICG angiography demonstrated bypass blood flow from the anastomosed STA to the cortical vessels in all patients. The ICG perfusion area in MD (20.7 ± 6.6 cm(2)) was significantly larger than that in non-MD (8.4 ± 9.1 cm(2), P < 0.05). The cortical oxygen saturation (58.9% ± 8.3%) in MD was significantly lower than that in non-MD (73.4% ± 9.5%, P < 0.05). CONCLUSIONS ICG angiography with injection of ICG into the bypass artery allowed quantitative assessment of bypass blood flow. The bypass supplies blood flow to a greater extent in MD than in non-MD during surgery. This might be caused by a larger pressure gradient between the anastomosed STA and recipient vessels in MD. These observations indicate that MD requires careful control of systemic blood pressure after surgery to avoid cerebral hyperperfusion syndrome. ICG angiography is considered useful for facilitating safe and accurate bypass surgery and providing information for postoperative management.

ICG fluorescence imaging and its medical applications

This paper presents a novel optical angiography system, and introduces its medical applications. We developed the optical enhanced imaging system which can observe the blood and lymphatic vessels as the Indocyanine green (ICG) fluorescence image. The imaging system consists of 760nm light emitted diode (LED) as excite light, CCD camera as a detector, a high-pass optical filter in front of the CCD and video processing system. The advantage of ICG fluorescence method is safe (radiation free), high sensitive, real time monitoring of blood and/or lymphatic flow, small size, easy to operate and cost effective compared to conventional X-ray angiography or scintigraphy. We have applied this method to several clinical applications such as breast cancer sentinel lymph node (SLN) navigation, lymph edema diagnostic and identification of liver segmentation. In each application, ICG fluorescence method shows useful result. Its indicated that this method is promising technique as optical angiography.

Development of a wireless near-infrared tissue oxygen monitor system with high sampling rate

We developed a portable near-infrared tissue oxygen monitor having both wireless data communication capability and high sensitivity. This device is able to measure relative changes in oxy- and deoxyhemoglobin concentrations in real time.

Characteristics of the Photodynamic Eye Camera

We developed near-infrared fluorescence imaging system for indocyanine green (ICG) as optical enhancer and tried to use the system for evaluation purpose of blood and/or lymphatic vessel observation during the operation. The excitation wavelength of ICG is in the near-infrared wavelength between 750 and 810 nm, and the fluorescence occurs maximum wavelength at 845 nm in plasma.