Combined use of intraoperative indocyanine green and dynamic angiography in rotational vertebral artery occlusion

Nauman S. Chaudhry, Sudheer Ambekar, Mohamed Elhammady, Jonathan P. Riley, Gustavo Pradilla, Raul G. Nogueira, Faiz U. Ahmad

Research output: Contribution to journalArticle

4 Scopus citations

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.

Original languageEnglish (US)
JournalJournal of Clinical Neuroscience
DOIs
StateAccepted/In press - Jan 29 2016

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Keywords

  • Bow hunter's syndrome
  • Dynamic angiography
  • Indocyanine green video angiography
  • Rotation vertebral artery occlusion
  • Vertebral artery

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Physiology (medical)

Cite this

Chaudhry, N. S., Ambekar, S., Elhammady, M., Riley, J. P., Pradilla, G., Nogueira, R. G., & Ahmad, F. U. (Accepted/In press). Combined use of intraoperative indocyanine green and dynamic angiography in rotational vertebral artery occlusion. Journal of Clinical Neuroscience. https://doi.org/10.1016/j.jocn.2016.02.007