Balloon Test Occlusion with Perfusion CT Imaging Utilizing Intraarterial Contrast Injection

Internal Carotid Artery Test Balloon Occlusion Using Single Photon Emission Computed Tomography Scan in the Management of Complex Cerebral Aneurysms and Skull Base Tumors: A 20-Year Review

BACKGROUND

Test balloon occlusion (TBO) is important in the management of complex cerebrovascular and skull base lesions when permanent occlusion (PO) of a parent artery may be indicated. Several adjuncts may be used to increase the sensitivity of TBO to predict whether PO will be tolerated. This is an observational study to evaluate the utility of internal carotid artery (ICA) TBO using single photon emission computed tomography (SPECT) scan in the management of complex vascular pathology and skull base tumors.

METHODS

All TBO procedures performed over a 20-year period were analyzed. Clinical assessment and angiographic collateral flow were combined with semi-quantitative cerebral blood flow analysis using ^99mTc hexamethylpropylene-amine oxime SPECT scan during ICA TBO. Evaluation of collateral circulation after TBO, and the complications of TBO and the safety of PO after successful TBO were evaluated.

RESULTS

Eighty-three patients underwent TBO without complication. Of 45 patients with satisfactory TBO, 28 proceeded to PO. Three patients developed transient ischemic symptoms thought to be embolic in origin. Thirty-eight patients had unsatisfactory TBO, of whom 15 required PO accompanied by a bypass procedure. Forty patients in the series did not undergo permanent vessel occlusion.

CONCLUSIONS

SPECT scan-enhanced TBO is an important component of the management of complex vascular pathology and skull base tumors, permitting safe PO of the parent vessel and definitive treatment of the main pathology.

Application and reliability of the superselective balloon occlusion test in the treatment of complex cerebral artery aneurysms: A report of 12 cases

Although the general balloon occlusion test (BOT) is commonly used, there is limited information on the evaluation standards and methodological protocols for the superselective BOT, which may be required in some special aneurysm cases. We performed the superselective BOT in 12 patients with specific complex aneurysms and report our experiences herein. We retrospectively analyzed the angiographic results and test outcomes of 12 patients (8 men and 4 women) who underwent the superselective BOT to evaluate their collateral flow before treatment. Eight patients had middle cerebral artery complex aneurysms; 2 patients had carotid-ophthalmic aneurysms; and 2 patients had posterior cerebral artery aneurysms. Collaterals were categorized as none (grade 0), poor (grades 1 or 2), or good (grades 3 or 4) based on the collateral flow grade on angiography. The test results were negative in 10 patients and positive in 2 patients. The delay time of the cortical capillary phase after temporary occlusion of the parent artery was between 0.5 and 2.5 s. The collateral flow was graded as poor in 3 patients and good in 9 patients. There were no technical complications related to the superselective BOT. The superselective BOT can be applied for the evaluation of some complex aneurysms prior to treatment. The right method of occlusion can be selected on the basis of the results of this test.