The recipient vascular characteristics are likely one of the key reasons for bypass failure in superficial temporal artery–middle cerebral artery (STA-MCA) bypass surgery. Most surgeons choose the recipient with the biggest diameter in their regular practise. However, choosing the appropriate recipient is difficult because there are no objective selection criteria when there are several candidates. In patients undergoing STA-MCA bypass surgery for hemodynamic impairment, the authors evaluated the benefit of utilising indocyanine green videoangiography (ICG-VA) to optimise recipient vascular selection. The identifiability of possible recipient vessels and abnormal flow patterns were determined by comparing preanastomosis white-light pictures. A second ICG-va picture is taken when the anastoosis is finished.

Patients had 65 STA-MCA bypass surgeries with ICG-VA pre- and post-anastomosis. The ICG VA allowed for a much higher number of potential recipient vessels to be identified than the white-light images. There was no link discovered between diameter and blood flow in probable recipients. The recipients with the greatest flow gain after bypass grafting were those who had a low flow to begin with. ICG-VA aids in the detection of abnormal flow patterns and the identification of suitable recipient vessels. Receivers with a low starting flow, a late appearance, and retrograde flow appear to have the greatest potential for flow increase, presumably due to a greater hemodynamic requirement for revascularization.

Reference Link – https://thejns.org/view/journals/j-neurosurg/135/1/article-p44.xml