Brain perfusion imaging during preoperative temporary balloon occlusion of the internal carotid artery.
The main objective of this study was to assess whether 99mTc-HMPAO brain SPECT imaging can identify patients at high risk of developing an infarct following permanent carotid occlusion in the course of brain surgery.


METHODS
Test balloon occlusion of the internal carotid artery was performed in 44 patients with a variety of head and neck tumors or aneurysms. Technetium-99m-HMPAO was injected intravenously while the balloon was initiated and a SPECT study was obtained 30 min later. Follow-up CT scans were obtained routinely for all patients at 2 wk and 1 mo following surgery, or earlier when necessary. Thirty patients and five normal volunteers had semiquantitative analysis of cerebral perfusion.


RESULTS
Twenty-six patients demonstrated ipsilateral perfusion abnormalities during trial occlusion. Eight patients in this group underwent bypass grafting prior to sacrifice of the artery: two resulting in infarcts. Eighteen patients had symmetric cerebral perfusion during occlusion and four of these patients underwent permanent therapeutic carotid occlusion; three patients had subsequent infarcts and the fourth patient had an impending stroke.


CONCLUSIONS
Patients with symmetric cerebral perfusion measured by 99mTc-HMPAO SPECT may still have a high long-term complication rate following carotid sacrifice. The scan findings in these patients were not predictive of the outcome. Patients with asymmetric cerebral perfusion had alternative therapeutic approach to carotid sacrifice and most of them had good surgical outcomes.
Lorberboym
M
M
Department of Radiology, Mount Sinai School of Medicine, New York, New York 10029, USA.
Pandit
N
N
Machac
J
J
Holan
V
V
Sacher
M
M
Segal
D
D
Sen
C
C
D001921:Brain / Q000000981:diagnostic imaging*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000503:physiopathology* / Q000601:surgery; D002404:Catheterization; D002544:Cerebral Infarction / Q000453:epidemiology* / Q000517:prevention & control; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010091:Oximes; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D012307:Risk Factors; D019690:Technetium Tc 99m Exametazime; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime