title: X-ray Angiography Perfusion Analysis for the Balloon Occlusion Test of the Internal Carotid Artery.
abstract: BACKGROUND
  A perfusion study should be performed during the balloon occlusion test (BOT) to prevent ischemic events after therapeutic carotid occlusion. We evaluated the efficacy of X-ray angiography perfusion analysis during the BOT.
  
  
  METHODS
  Twenty-one consecutive patients who underwent the BOT of the internal carotid artery were included. Patients who had a venous phase delay of less than .5 seconds and a mean stump pressure of more than 50 mm Hg without any neurologic symptoms were considered tolerant, and other patients were considered intolerant. A time-density curve was constructed for each hemisphere using X-ray angiography perfusion software (2D-Perfusion). The mean transit time and area under the curve, which correspond to cerebral blood volume, were calculated from the curve. Differences in these parameters between the occluded and nonoccluded hemispheres and the perfusion index were compared between the tolerant and intolerant groups.
  
  
  RESULTS
  In the intolerant group, the mean transit time was significantly longer (1.31 ± .72 seconds versus .44 ± .21 seconds, P = .001) and the perfusion index was significantly lower (.72 ± .16 versus .94 ± .08, P = .001) compared with those in the tolerant group. The area under the curve was not different between the groups.
  
  
  CONCLUSIONS
  Parameters obtained by X-ray angiography perfusion analysis were significantly different between the tolerant and intolerant groups. The X-ray angiography perfusion analysis could be a safe and effective method for assessing ischemic tolerance before therapeutic carotid occlusion.
authors: Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan. Electronic address: asai-osk@umin.ac.jp.
authors: Katsunori
authors: K
authors: Asai
authors: Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
authors: Hirotoshi
authors: H
authors: Imamura
authors: Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan.
authors: Yohei
authors: Y
authors: Mineharu
authors: Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
authors: Shoichi
authors: S
authors: Tani
authors: Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
authors: Hidemitsu
authors: H
authors: Adachi
authors: Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
authors: Osamu
authors: O
authors: Narumi
authors: Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
authors: Shinsuke
authors: S
authors: Sato
authors: Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan.
authors: Chiaki
authors: C
authors: Sakai
authors: Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan.
authors: Nobuyuki
authors: N
authors: Sakai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D019540:Area Under Curve; D021721:Balloon Occlusion / Q000009:adverse effects; D001783:Blood Flow Velocity; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000503:physiopathology; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D012039:Regional Blood Flow; D012984:Software; D013997:Time Factors
chemical_list: D003287:Contrast Media
keywords: 2D perfusion; Balloon occlusion test; X-ray angiography perfusion; internal carotid artery