Assessment of brain tolerance to ischemia with temporary balloon occlusion / 介入放射学杂志

ABSTRACT

Objective Attempting to find a reliable method for assessing the patient's ability to tolerate carotid artery occlusion. Methods The temporary balloon occlusion (TBO) test of carotid artery was performed for 20 patients who might have carotid artery manipulated or permanently occluded. Transfemoral artery Seldinger's catheterization was used to introduced the temporary balloon occlusion catheters into the vessels of the concern. Neurologic testing was performed continuously by the attending neurologist. Transcranial Doppler ultrasonography (TCD) and carotid artery stump pressure (SP) were measured contiuously during the TBO. The collateral circulation of Willis circle was observed with DSA. Results Out of the 20 cases, one failed during the TBO because of CCA dissection caused by catheterization, another one failed because of a neurologic defect occurring before the balloon was inflated, the others went through the test uneventfully. Two cases finished the test before the approved schedule because neurologic defects appeared 34 min and 27 min after the vascular occlusion, respectively. These two patients were proved unable to tolerate carotid artery sacrifice. The other 16 cases passed the 45 minutes TBO. Their mean velocity of ipsilateral middle cerebral artery fell 36%?18%. Their SP is (53.76?21.49) mmHg(30-87). Adequate collateral circulation in Willis circle was observed by DSA in all cases except the two who failed with the TBO. Conclusions TBO is a safe and reliable method for assessing the patient's ability to tolerate carotid artery occlusion. We suggest it should be a routine examination prior to carotid manipulations.