Abstract
Objective To ascertain the predictive value of intra-operative FLOW 800 vascular map model in predicting onset of post-operative clinical vasospasm and delayed cerebral ischemia among patients undergoing micro-vascular clipping of ruptured intracranial aneurysms. Material and methods A total of 40 patients were enrolled in the study and their variables such as age, World Federation of Neurological Surgeons (WFNS) grade at presentation, Computerized Tomography (CT) Fisher grading, location of the aneurysms, and Indocyanine Green (ICG) flow status were compared and statistically analyzed along with differences in Absorption Intensities (AI) and difference in time lag values obtained from the FLOW 800 vascular map studies for predicting onset of vasospasm. Results The Receiver Operating curve (ROC) of the model for predicting post-operative vasospasm was highest (.892) for difference in the AI followed by CT Fisher grading (.778), difference in time lag (.700) and WFNS grading (.699).Analysis of variance for different variables studied in our model for predicting vasospasm was significant for all except for age (.991) and the ICG flow through the parent vessel (.079).Multivariate analysis done for predicting the vasospasm was significant for all variables except for age (.869) and ICG main flow (.196) Conclusion Our study confirmed the role of FLOW 800 study model in predicting clinical vasospasm. Inclusion of this entity would therefore help in taking timely and correct therapeutics measures to ensure better patient outcomes.
Highlights
Progressive narrowing of vessels can occur in up to 70% of patients within 2 weeks of intra-cranial aneurysmal rupture, among which 30% develop delayed ischemic neurological deficits[1,2]
Since indocyanine green (ICG) flow studies are safe, applicable, readily reproducible and routinely utilized technique during the microvascular clipping of aneurysms, addition of FLOW 800, an automated vascular map study generated by the microscope with the provision for quantitative study of flow velocities and time lag for appearance of the dye between relevant vessels, can help us segregate and outline groups at high-risk of developing post-operative vasospasm and form an evidencebased management algorithm for better therapeutic benefits and clinical outcomes
In our study model of FLOW 800 mapping, the lower normal limit for normal difference in average absorption intensity (DfAI) between the parent and the branching vessel was taken at 50%
Summary
Progressive narrowing of vessels can occur in up to 70% of patients within 2 weeks of intra-cranial aneurysmal rupture, among which 30% develop delayed ischemic neurological deficits[1,2]. Since indocyanine green (ICG) flow studies are safe, applicable, readily reproducible and routinely utilized technique during the microvascular clipping of aneurysms, addition of FLOW 800, an automated vascular map study generated by the microscope with the provision for quantitative study of flow velocities and time lag for appearance of the dye between relevant vessels, can help us segregate and outline groups at high-risk of developing post-operative vasospasm and form an evidencebased management algorithm for better therapeutic benefits and clinical outcomes. ○ “Indocyanine green (ICG) flow studies are safe, applicable, readily reproducible and routinely used during the microvascular clipping of aneurysms. The authors could break up the sentences with pertinent references so that it is understood. ○ “Indocyanine green (ICG) flow studies are safe, applicable, readily reproducible and routinely used during the microvascular clipping of aneurysms. [Reference?] ○ A note on current status of ICG studies in predicting vasospasm would be better here
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