Role of Digital Subtraction Angiography (DSA) and Indocyanine Green Videoangiography (ICG) in the operative management of aneurysmal subarachnoid haemorrhage

Abstract

Background: Aneurysm subarachnoid haemorrhage (SAH) is a leading cause of mortality (40 % - 50% of SAH). Digital Subtraction Angiography( DSA) remains the gold-standard study for the radiographic diagnosis and pre-treatment planning for patients with brain aneurysms and adequacy of clipping. Intraoperative indocyanine green (ICG) videoangiography  has been increasingly utilized to confirm optimal clip positioning across the neck, to evaluate the patency of adjacent vasculature and potentially obviate the need for intraoperative DSA.

Objective : To study and compare the efficacy of intraoperative ICG with post – operative DSA and to study complications of DSA.

Study Design : A prospective  study conducted in 30 patients from September 2017 to September 2020  with aneurysmal SAH who underwent clipping of intracranial  aneurysm. Indocyanine green angiography was done during the surgery and the findings of  intra operative ICG angiography were compared with post –operative DSA. Complications of DSA were also looked upon.

Results : Our study included 30 patients with mean age of 42.7 years. Complete aneurysm obliteration was demonstrated in 100% patients and distal branch patency in 26 (87.6%) patients in ICG. However these results were after repositioning of the aneurysm clips done during the ICG angiography. Postoperative DSA showed complete aneurysm obliteration in 27 (90%) patients, distal branch patency in 27 (90%) patients and incomplete aneurysm obliteration with residual neck in 3 (10%) patients. Groin hematoma occurred in  4 (13.3%) patients, seizures in 1 (3.3%) patient and contrast reaction in 1(3.3%) patient.

Conclusion : DSA is more sensitive than ICG in depicting residual neck however in our study  we found ICG – VA is neck to neck in competition with DSA.