[Endovascular balloon occlusion test of the internal carotid artery with increased hemodynamic monitoring for determination of circulatory reserve before planned carotid occlusion].

PURPOSE

To evaluate stroke risk assessment of balloon test occlusion of the internal carotid artery (ICA) with enlarged haemodynamic monitoring prior to permanent ICA occlusion.

MATERIAL AND METHODS

24 patients with cervical metastasis (n = 18), cavernous meningiomas (n = 3) or inoperable cavernous aneurysms (n = 3) were examined. The test occlusion was monitored by EEG, neurological examinations and transcranial Doppler sonography of the ipsilateral middle cerebral artery with evaluation of the cerebrovascular reserve capacity. Additionally 99mTc-HMPAO-SPECT imaging was added showing the perfusion during test occlusion.

RESULTS

In one (4%) patient the test occlusion had to be interrupted previously due to an acute neurological deficit. This patient and two (8%) patients with highly pathological test results in SPECT and TCD were excluded from permanent carotid occlusion. In 6 (25%) patients quantitative TCD monitoring could improve the stroke risk assessment by differentiating the patients in a low and high risk group. 6 (25%) patients were definitely occluded without haemodynamic complications, but two patients suffered from embolic infarctions which cannot be predicted by this procedure.

CONCLUSIONS

The multimodal balloon test occlusion with enlarged haemodynamic monitoring allows haemodynamic stroke risk assessment prior to permanent occlusion of the ICA.