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Neurological Surgery No Shinkei Geka Volume 40, Issue 4 （April 2012）

Neurological Surgery 脳神経外科 40巻4号（2012年4月発行）

Japanese English

研究

頚動脈内膜剝離術におけるICG螢光血管撮影の有用性（第2報）：FLOW800システムを用いた偽閉塞・高度狭窄例の検討 Efficacy of Indocyanine Green Videoangiography for Carotid Endarterectomy 大川将和 ¹ , 安部洋 ¹ , 緒方利安 ¹ , 野中将 ¹ , 上羽哲也 ¹ , 東登志夫 ¹ , 井上亨 ¹ Masakazu OKAWA ¹ , Hiroshi ABE ¹ , Toshiyasu OGATA ¹ , Masaru NONAKA ¹ , Tetsuya UEBA ¹ , Toshio HIGASHI ¹ , Tooru INOUE ¹ ¹福岡大学医学部脳神経外科 ¹Department of Neurosurgery,Faculty of Medicine,Fukuoka University キーワード： carotid endarterectomy , indocyanine green video-angiography Keyword: carotid endarterectomy , indocyanine green video-angiography pp.309-317

発行日 2012年4月10日 Published Date 2012/4/10

DOI https://doi.org/10.11477/mf.1436101694

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　ICG螢光血管撮影（indocyanine green videoangiography：ICG-VA）は脳血管障害の分野で広く普及しつつあり，ますます重要性が増してきている．Carl Zeiss社の顕微鏡OPMI^® Pentero INFRARED 800で撮影したICG-VAのデータの経時的輝度解析が可能となるFLOW800システムが開発され，われわれの施設にも導入された．以前われわれは頚動脈内膜剝離術（carotid endarterectomy：CEA）におけるICG-VAの有用性を報告した⁷⁾が，このシステムを偽閉塞を含む高度狭窄症例に用いて新たな知見を得たので報告する．

　Objective: The aim of the present study is to assess whether the technique of surgical microscope-based indocyanine green videoangiography (ICG-VA) and the FLOW800 system are efficient for hemodynamic evaluation during carotid endarterectomy (CEA).

　Methods: 20 CEAs for 19 patients were performed from January to July 2011. Before and after endarterectomy, ICG was injected intravenously. After the procedure, ICG-VA was analyzed by FLOW800. Regions of interest were the common carotid artery, the plaque, the internal carotid artery, and the external carotid artery to evaluate changes in each intensity value.

　Results: The distal end of carotid plaque and the proximal end were identified in 85% of CEAs and 78.9% of cases. In 5 cases (26.3%) with more severe stenosis (＞90%), the decrease of blood flow intensity in the internal carotid artery was delayed before endarterectomy. After endarterectomy, the finding was improved in all the 5 cases. After the endarterectomy, the intensity values in the common carotid artery, the plaque, the internal carotid artery, and the external carotid artery had increased 162±129, 337±212, 139±151 and 177±143. Especially in the value of the plaque, there was a great improvement.

　Conclusions: ICG-VA provides information of the plaque location and the patency of the arterial vessel during CEA. Using FLOW800,semiquantitive information of hemodynamics was able to be acquired,especially for the case of severe stenosis with collapse of the internal carotid artery.