title: Balloon test occlusion of the internal carotid artery with stump pressure ratio and venous phase delay technique.
abstract: Balloon test occlusion (BTO) is crucial before sacrificing parent arteries. We proposed a simple paradigm combining clinical tolerance with venous phase technique and stump pressure ratio as a criterion for sufficient collateral flow. Internal carotid artery (ICA) occlusion was considered safe for asymptomatic patients who exhibited less than 2 seconds of venous phase delay or had a stump pressure ratio greater than 60%. A total of 37 BTO procedures were performed on 31 patients. Twenty-three patients were monitored clinically and 3 were symptomatic. Venous phase comparison was performed on 27 patients, and 5 failed the test. The stump pressure was measured in all patients, and 7 patients failed the test. In summary, 7 patients failed the BTO, of which 6 received high-flow bypass and 1 of these 6 were symptomatic and exhibited stump pressure ratios less than 60% in the second BTO procedure. Occlusion of the ICA was performed on 29 patients. Only 1 patient developed delayed vasospasm and brain infarction. Adequate collateral flow may be indicated by a stump ratio of 60% or greater with or without a high-flow bypass. Combined with clinical assessment and venous phase technique, ICA occlusion may be a safe option that does not result in delayed ischemic complications.
authors.affiliation: Department of Neurosurgery, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China. Electronic address: stroke2000@gmail.com.
authors.forename: Alvin Yi-Chou
authors.initials: AY
authors.lastname: Wang
authors.forename: Ching-Chang
authors.initials: CC
authors.lastname: Chen
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Lai
authors.forename: Shih-Tseng
authors.initials: ST
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D021721:Balloon Occlusion / Q000009:adverse effects; D002343:Carotid Artery, Internal / Q000503:physiopathology*; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aneurysmal subarachnoid hemorrhage; balloon occlusion; cerebral aneurysm; internal carotid artery; therapeutic embolization