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

 Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA

Correspondence Address:
Mohamed Samy Elhammady,
Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 2nd Floor, 1095 NW 14th Terrace (D4-6), Miami, Florida 33136
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Source of Support: None, Conflict of Interest: None

Rotational vertebral artery occlusion (RVAO) is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. We report a case of RVAO in which intraoperative indocyanine green angiography (ICGA) was used to confirm adequate surgical decompression of the VA. A 57-year-old female who presented with multiple episodes of syncope provoked by turning her head to the right. Rotational dynamic angiography revealed a dominant right VA that became occluded at the level of C5/6 with head rotation to the right. The patient underwent successful surgical decompression of the VA via an anterior cervical approach. ICGA demonstrated VA patency with head rotation. This was further confirmed by intraoperative dynamic catheter angiography. To the best of our knowledge, we present the first use of ICG combined with intra-operative dynamic rotational angiography to document the adequacy surgical decompression of the VA in a patient with RVAO.

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    -  Chaudhry N
    -  Gaynor BG
    -  Ambekar S
    -  Elhammady MS
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