[Visualization of the distal edge of carotid plaque using indocyanine green videoangiography during carotid endarterectomy and the pitfall involved].

OBJECTIVE:Microscope-integrated near-infrared indocyanine green video angiography (ICG-VA) is a new method of intraoperative blood flow assessment. The objective of this study was to evaluate the efficacy of ICG-VA in carotid endarterectomy to visualize the carotid plaque area, especially the distal end. METHODS:Twenty patients who underwent carotid endarterectomy were included. Before arteriotomy and after vessel closure, ICG was injected intravenously. The plaque area and patency of the carotid artery were assessed. RESULTS:In all cases, the distal end of the carotid plaque was identified and the patency of the internal carotid artery was confirmed after excision of plaque. In seventeen cases (85.0%), the proximal end was also identified. The internal surface of carotid plaque was not seen. Some images show reflux of contrast medium into the internal jugular after a left-arm injection. CONCLUSIONS:ICG-VA provides real-time information on the carotid plaque area and the patency of arterial vessel during surgical procedure. It is necessary to pay special attention to injection routes, existence of any foreign body and the influence of hemostasis in order to get better contrast. ICD-VA would be a useful adjunct to improve the quality of CEA.