Temporary endovascular balloon occlusion of the internal carotid artery with a nondetachable silicone balloon catheter: analysis of technique and cost.
OBJECTIVE
Temporary balloon occlusion has become a routine and medically accepted technique for the management of patients with aneurysms or intracranial or head/neck tumors. We describe our experience using a nondetachable silicone balloon (NDSB) catheter in 103 endovascular temporary balloon occlusions of the internal carotid artery, with attention focused on technique, complications, and cost.


METHODS
Between 1993 and 1998, 103 patients underwent preoperative temporary balloon occlusion testing with a 1.5-mm NDSB catheter. Clinical testing during endovascular blockade was combined with qualitative cerebral blood flow analysis using technetium-99m HMPAO SPECT. Cost-effective analysis was performed, emphasizing cost and complication rates in comparison with those in previously reported series in which multiple types of temporary balloon occlusion catheters were used, predominantly not of the NDSB type.


RESULTS
No carotid artery injury or complication, including cerebral infarction due to NDSB use, was encountered. Despite the increased cost of the NDSB catheter system, cost-effective analysis showed up to 40% reduction in cost per quality adjusted life years.


CONCLUSIONS
Temporary balloon occlusion using the NDSB catheter is safe and cost-effective, owing to the low rate of complications.
D000368:Aged; D002343:Carotid Artery, Internal / Q000503:physiopathology*; D002404:Catheterization / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology; D003362:Cost-Benefit Analysis; D004621:Embolization, Therapeutic / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D009460:Neurologic Examination; D011300:Preoperative Care; D019057:Quality-Adjusted Life Years; D019275:Radiopharmaceuticals; D012039:Regional Blood Flow / Q000502:physiology; D012307:Risk Factors; D012449:Safety; D012828:Silicones; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon