Intraoperative Indocyanine Green Fluorescence Angiography for Real-Time Validation of Carotid Artery Patency Following Resection of Advanced Carotid Body Tumors

TL;DR

This paper presents a case where intraoperative ICG-FA was used to confirm carotid artery patency after surgery for a complex carotid body tumor.

Contribution

Demonstrates the use of ICG-FA as a real-time tool for validating carotid patency after tumor resection.

Findings

ICG-FA showed immediate and homogeneous perfusion of the reconstructed carotid artery.

The patient had no postoperative neurologic or vascular complications.

The technique proved effective in confirming vascular integrity during complex tumor surgery.

Abstract

Carotid body tumors (CBTs) are rare paragangliomas arising at the carotid bifurcation, with Shamblin III lesions posing substantial operative risk due to circumferential arterial encasement. When arterial resection and reconstruction are required, reliable confirmation of carotid perfusion is essential. This is the case of a 24-year-old male patient with a right-sided Shamblin III CBT managed with preoperative embolization, segmental internal fluorescence-guided carotid artery resection, and end-to-end reconstruction. Intraoperative indocyanine green fluorescence angiography (ICG-FA) demonstrated immediate, homogeneous perfusion across the reconstructed segment, with no delay or focal hypofluorescence. The postoperative course was uneventful, with no neurologic or vascular complications. This case illustrates the potential role of intraoperative ICG-FA as a real-time adjunct to confirm carotid patency and perfusion following complex vascular tumor resection.

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