Multimodal Assessment for Balloon Test Occlusion of the Internal Carotid Artery

Abstract

Objective: Permanent therapeutic occlusion of the carotid artery is one of the treatment options for patients with a large/ giant internal carotid artery aneurysm or tumor involving the neck or skull base. Balloon test occlusion (BTO) is performed to predict the tolerance of parent artery occlusion (PAO). The authors combined various modalities to improve the sensitivity of BTO. The purpose of this study is to present the efficacy of the multimodal BTO. Results: By multimodal assessment of BTO, 33 patients were considered tolerable, six were partially tolerable, and 11 were intolerable. Thirteen of 33 patients with predictive tolerance underwent PAO without bypass, and all but one showed no hemodynamic ischemia postoperatively. Three of six patients with predictive partial tolerance were treated by PAO with extracranial-intracranial bypass, and they experienced no hemodynamic ischemia. In contrast, one with predictive partial tolerance treated by PAO without bypass developed ischemic events as feared. Conclusion:The multimodal BTO is helpful to evaluate the tolerance of PAO and is a reliable predictor of postoperative ischemic events. It reduces risks and increases treatment safety for permanent therapeutic occlusion of the carotid artery.

Carotid bypass surgery for a persistent neck tumor after multiple treatments: a case report

“…The balloon occlusion test is an angiographic test performed to evaluate cerebral ischemic tolerance in patients undergoing therapeutic ICA ligation and bypass surgery. 9,10 Although the balloon occlusion test has a false negative risk of 3.3-10.0% when the complication rate is compared between those who undergo ICA occlusion without and with balloon occlusion tests, the number reaches 26% with a 12% mortality rate related to cerebral infarction. These complications are reduced to 13% when balloon occlusion tests are performed.…”

Ophthalmic Artery Flow Pattern-related Stump Pressure and Ischemic Tolerance during Balloon Test Occlusion of the Internal Carotid Artery

“…The thromboembolic complication rate associated with BTO was reported to be 0.8%–6.0%. 12 – 16) In most facilities, a 20-min temporary ICA occlusion is performed to evaluate the neurological symptoms during BTO. Our findings suggest that patients with type III OphA flow can avoid this 20-min temporary ICA occlusion.…”

“…BTO is an invasive test associated with thromboembolic complications of 0.8–6.0%, 12 – 16) partly due to the prolonged ICA occlusion. To reduce the complication rate, we focused on determination of the ophthalmic artery (OphA) flow direction just after ICA temporary occlusion because OphA flow direction might be associated with intracranial collateral perfusion.…”