title: Venous phase timing during balloon test occlusion as a criterion for permanent internal carotid artery sacrifice.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the reliability of angiography-based balloon test occlusion (BTO) criteria to decide whether to perform internal carotid artery (ICA) permanent occlusion.
  
  
  METHODS
  From March 1999 to August 2004, 60 patients underwent therapeutic ICA occlusion. Angiographic BTO was performed systematically in all patients under general anesthesia (GA). No clinical examination test was performed. After balloon inflation, contralateral carotid and vertebral arteries angiograms were obtained. The symmetry of the venous phases of each hemisphere was assessed. Occlusion was considered to be feasible when the delay between the venous drainage of the injected and the occluded hemisphere was not >2 seconds. Venous drainage delay >4 seconds was considered as contraindication to ICA permanent occlusion. In patients with venous drainage delay of 2-4 seconds, the occlusion was performed only in selected cases.
  
  
  RESULTS
  From a total of 60 patients, 44 had exact symmetry of the venous phase, 10 had delay of 1 second, and 3 other patients had 2-second delays. Clinical outcome for these 57 patients was uneventful. Three patients had venous drainage delay of 3 seconds. One of them had delayed watershed area infarction without clinical consequences at the time of hospital discharge. No periprocedural complications were observed.
  
  
  CONCLUSIONS
  Venous opacification symmetry in the tested and control vascular territories was a reliable predictor of a subject's ability to tolerate carotid occlusion without developing neurologic deficit. Carotid sacrifice was found to be possible when the delay was <3 seconds.
authors.affiliation: Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France.
authors.forename: Daniel Giansante
authors.initials: DG
authors.lastname: Abud
authors.forename: Laurent
authors.initials: L
authors.lastname: Spelle
authors.forename: Michel
authors.initials: M
authors.lastname: Piotin
authors.forename: Charbel
authors.initials: C
authors.lastname: Mounayer
authors.forename: Jose Ricardo
authors.initials: JR
authors.lastname: Vanzin
authors.forename: Jacques
authors.initials: J
authors.lastname: Moret
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D021721:Balloon Occlusion / Q000379:methods* / Q000592:standards; D001794:Blood Pressure / Q000502:physiology; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results; D013687:Telencephalon / Q000098:blood supply; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome