[Endovascular balloon occlusion test of the internal carotid artery with increased hemodynamic monitoring for determination of circulatory reserve before planned carotid occlusion].
OBJECTIVE
To evaluate stroke risk assessment of balloon test occlusion of the internal carotid artery (ICA) with enlarged haemodynamic monitoring prior to permanent ICA occlusion.


METHODS
24 patients with cervical metastasis (n = 18), cavernous meningiomas (n = 3) or inoperable cavernous aneurysms (n = 3) were examined. The test occlusion was monitored by EEG, neurological examinations and transcranial Doppler sonography of the ipsilateral middle cerebral artery with evaluation of the cerebrovascular reserve capacity. Additionally 99mTc-HMPAO-SPECT imaging was added showing the perfusion during test occlusion.


RESULTS
In one (4%) patient the test occlusion had to be interrupted previously due to an acute neurological deficit. This patient and two (8%) patients with highly pathological test results in SPECT and TCD were excluded from permanent carotid occlusion. In 6 (25%) patients quantitative TCD monitoring could improve the stroke risk assessment by differentiating the patients in a low and high risk group. 6 (25%) patients were definitely occluded without haemodynamic complications, but two patients suffered from embolic infarctions which cannot be predicted by this procedure.


CONCLUSIONS
The multimodal balloon test occlusion with enlarged haemodynamic monitoring allows haemodynamic stroke risk assessment prior to permanent occlusion of the ICA.
Keller
E
E
Radiologische Klinik, Universität Bonn.
Ries
F
F
Urbach
H
H
Gass
S
S
Gräunwald
F
F
Solymosi
L
L
Schild
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002404:Catheterization; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000517:prevention & control; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging / Q000517:prevention & control; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D009460:Neurologic Examination; D015609:Organotechnetium Compounds; D010091:Oximes; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology; D012307:Risk Factors; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
D003287:Contrast Media; D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime
Endovaskulärer Ballonokklusionstest der A. carotis interna mit erweitertem hämodynamischen Monitoring zur Bestimmung der Durchblutungsreserve vor geplantem Karotisverschluss.