{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T16:13:20Z","timestamp":1773677600182,"version":"3.50.1"},"reference-count":19,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Selection of the optimal recipient artery in superficial temporal artery to middle cerebral artery (STA\u2013MCA) extracranial\u2013intracranial bypass surgery is essential to ensure adequate cerebral perfusion. Various pre- and intraoperative tools for target vessel selection have been proposed. Indocyanine green fluorescence video angiography (ICG-VA) enables real-time visualization of cerebral hemodynamics, facilitating recipient vessel selection and anastomotic evaluation. Here, we review the literature and present the use of qualitative ICG-VA to support intraoperative decision-making during double-barrel (DB) STA\u2013MCA bypass surgery. Case description: We report the case of a 68-year-old patient with bilateral steno-occlusive cerebrovascular disease, who developed progressive hemodynamic compromise of the left hemisphere after prior right-sided STA-MCA bypass. Preoperative imaging demonstrated impaired perfusion and posterior-to-anterior leptomeningeal collateralization from the posterior cerebral artery. During the left-sided DB bypass surgery, intravenous ICG-VA was used to assess relative cortical perfusion. Two superficial M4 branches with the most pronounced perfusion delay were selected as recipients based on the ICG-VA and anatomical criteria. Postoperative angiography confirmed graft patency. At short-term follow-up, the patient remained neurologically stable, with complete regression of preoperative symptoms. Conclusions: This case illustrates the application of qualitative ICG-VA for perfusion-oriented recipient vessel selection in DB STA-MCA bypass for steno-occlusive disease. Real-time perfusion assessment may complement conventional anatomical criteria for recipient vessel selection in flow-augmentation procedures. Further studies incorporating quantitative hemodynamic analysis are warranted.<\/jats:p>","DOI":"10.3390\/brainsci16030316","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T14:30:32Z","timestamp":1773671432000},"page":"316","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Selection of Recipient Vessels in Double-Barrel STA-MCA Bypass Surgery with the Assistance of Intraoperative ICG Fluorescence: A Case Report and Review of the Literature"],"prefix":"10.3390","volume":"16","author":[{"given":"Stefanie","family":"Bauer","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1569-6376","authenticated-orcid":false,"given":"Timo","family":"Kahles","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kantonsspital Aarau, 5001 Aarau, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Diepers","sequence":"additional","affiliation":[{"name":"Institute of Neuroradiology, Department of Radiology, Kantonsspital Aarau, 5001 Aarau, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9135-6042","authenticated-orcid":false,"given":"Gerrit A.","family":"Schubert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland"},{"name":"Department of Neurosurgery, RWTH Aachen University Hospital Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1764-688X","authenticated-orcid":false,"given":"Lukas","family":"Andereggen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland"},{"name":"Faculty of Medicine, University of Bern, 3012 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serge","family":"Marbacher","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland"},{"name":"Faculty of Medicine, University of Bern, 3012 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1161\/STROKEAHA.115.008220","article-title":"Role of and Indications for Bypass Surgery After Carotid Occlusion Surgery Study (COSS)?","volume":"47","author":"Esposito","year":"2016","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s10143-018-0966-9","article-title":"Bypass in Neurosurgery\u2014Indications and Techniques","volume":"42","author":"Wessels","year":"2019","journal-title":"Neurosurg. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1001\/jama.2011.1610","article-title":"Extracranial-Intracranial Bypass Surgery for Stroke Prevention in Hemodynamic Cerebral Ischemia: The Carotid Occlusion Surgery Study Randomized Trial","volume":"306","author":"Powers","year":"2011","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"124308","DOI":"10.1016\/j.wneu.2025.124308","article-title":"Indications and Outcomes of Intracranial Bypass: A Systematic Review and Meta-Analysis","volume":"201","author":"Sadigh","year":"2025","journal-title":"World Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1161\/STROKEAHA.123.043634","article-title":"Future of Endovascular and Surgical Treatments of Atherosclerotic Intracranial Stenosis","volume":"55","author":"Elder","year":"2024","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e408","DOI":"10.1016\/j.wneu.2019.01.089","article-title":"Single-Barrel Versus Double-Barrel Superficial Temporal Artery to Middle Cerebral Artery Bypass: A Comparative Analysis","volume":"125","author":"Burkhardt","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1093\/ons\/opx119","article-title":"Double-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass: Can It Be Considered \u201cHigh-Flow\u201d?","volume":"14","author":"Cherian","year":"2018","journal-title":"Oper. Neurosurg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"88","DOI":"10.4103\/1793-5482.92168","article-title":"Intra Operative Indocyanine Green Video-Angiography in Cerebrovascular Surgery: An Overview with Review of Literature","volume":"6","author":"Balamurugan","year":"2011","journal-title":"Asian J. Neurosurg."},{"key":"ref_9","first-page":"132","article-title":"Near-Infrared Indocyanine Green Video Angiography: A New Method for Intraoperative Assessment of Vascular Flow","volume":"52","author":"Raabe","year":"2003","journal-title":"Neurosurgery"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"692","DOI":"10.3171\/jns.2005.102.4.0692","article-title":"Intraoperative Control of Extracranial\u2014Intracranial Bypass Patency by near-Infrared Indocyanine Green Videoangiography","volume":"102","author":"Woitzik","year":"2005","journal-title":"J. Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e186","DOI":"10.1016\/j.wneu.2018.09.195","article-title":"The Application of FLOW 800 ICG Videoangiography Color Maps for Neurovascular Surgery and Intraoperative Decision Making","volume":"122","author":"Shah","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"ons209","DOI":"10.1227\/NEU.0b013e31823158f3","article-title":"Flash Fluorescence with Indocyanine Green Videoangiography to Identify the Recipient Artery for Bypass With Distal Middle Cerebral Artery Aneurysms: Operative Technique","volume":"70","author":"Lawton","year":"2012","journal-title":"Oper. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/978-3-319-73739-3_12","article-title":"Role of Indocyanine Green Videoangiography in Identification of Donor and Recipient Arteries in Cerebral Bypass Surgery","volume":"Volume 129","author":"Esposito","year":"2018","journal-title":"Trends in the Management of Cerebrovascular Diseases"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"18352","DOI":"10.1038\/s41598-023-45676-1","article-title":"The Value of Indocyanine Green-FLOW800 in Microvasculature for Predicting Cerebral Hyperperfusion Syndrome in Moyamoya Disease Patients","volume":"13","author":"Guo","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ni, H., Wu, Y., Zhou, C., Li, X., Zhou, S., Lan, W., Zhang, Z., Huang, Y., Wang, H., and Lin, J. (2023). Application of Intraarterial Superselective Indocyanine Green Angiography in Bypass Surgery for Adult Moyamoya Disease. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1241760"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s41016-018-0129-4","article-title":"Usefulness of Intraoperative Indocyanine Green Video Angiography to Select the Recipient Artery for Bypass Surgery in Arteriosclerotic Occlusion of the Middle Cerebral Artery: A Technical Case Report","volume":"4","author":"Matsumoto","year":"2018","journal-title":"Chin. Neurosurg. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3171\/2020.5.JNS20642","article-title":"Indocyanine Green Videoangiography for Recipient Vessel Stratification in Superficial Temporal Artery\u2013Middle Cerebral Artery Bypass Surgery","volume":"135","author":"Goldberg","year":"2020","journal-title":"J. Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"ons274","DOI":"10.1227\/NEU.0b013e3182684c45","article-title":"Selective-Targeted Extra-Intracranial Bypass Surgery in Complex Middle Cerebral Artery Aneurysms: Correctly Identifying the Recipient Artery Using Indocyanine Green Videoangiography","volume":"71","author":"Esposito","year":"2012","journal-title":"Oper. Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/978-3-319-02411-0_10","article-title":"Selective Targeted Cerebral Revascularization via Microscope Integrated Indocyanine Green Videoangiography Technology","volume":"Volume 119","author":"Tsukahara","year":"2014","journal-title":"Trends in Neurovascular Interventions"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/3\/316\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T14:44:53Z","timestamp":1773672293000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/3\/316"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["brainsci16030316"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16030316","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,16]]}}}