Carotid Artery Balloon Test Occlusion: Combined Clinical Evaluation and Xenon-enhanced Computed Tomographic Cerebral Blood Flow Evaluation without Patient Transfer or Balloon Reinflation: Technical Note

Carotid Artery Balloon Test Occlusion: Combined Clinical Evaluation and Xenon-enhanced Computed... AbstractOBJECTIVE:Clinical evaluation was combined with xenon-enhanced computed tomographic (CT) cerebral blood flow (CBF) evaluation during carotid artery balloon test occlusion (BTO), without patient transfer from the angiography suite to the CT scanner or balloon reinflation.TECHNIQUE:Thirteen patients underwent carotid artery BTO. Placement of temporary occlusion balloons was performed with patients positioned on the CT scanner table. If neurological testing revealed no changes within 10 minutes after balloon inflation, patients were positioned within the CT scanner gantry for xenon-enhanced CT CBF evaluation. CBF evaluations were begun 12 to 15 minutes after balloon inflation and required 8 minutes for completion. After completion of CBF evaluation, neurological testing continued during 30 minutes of arterial occlusion.RESULTS:One patient did not tolerate BTO, with the development of reversible hemiparesis. Reliable CBF data were not obtained because of patient motion in one case. Eleven patients clinically tolerated BTO and completed CBF evaluation. For five patients, xenon-enhanced CT scanning revealed no regions with CBF of less than 30 ml/100 g/min. For four patients, xenon-enhanced CT scanning revealed small regions with CBF of less than 30 ml/100 g/min within the anterior frontal lobe on the occluded side. For two patients, ipsilateral CBF decreased dramatically during BTO, with CBF in many regions of less than 30 ml/100 g/min and in some of less than 20 ml/100 g/min.CONCLUSION:Xenon-enhanced CT CBF evaluation can be combined with clinical testing during BTO without patient transfer, balloon reinflation, or increases in the duration of the procedure. We recognize that the value of CBF evaluation during BTO remains to be proven; our technique does, however, eliminate abbreviated clinical neurological evaluation, patient transfer, and balloon reinflation, which were previously associated with the use of xenon-enhanced CT CBF evaluation during carotid artery BTO. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Carotid Artery Balloon Test Occlusion: Combined Clinical Evaluation and Xenon-enhanced Computed Tomographic Cerebral Blood Flow Evaluation without Patient Transfer or Balloon Reinflation: Technical Note

Carotid Artery Balloon Test Occlusion: Combined Clinical Evaluation and Xenon-enhanced Computed Tomographic Cerebral Blood Flow Evaluation without Patient Transfer or Balloon Reinflation: Technical Note

T E C H N IC A L N O T E S o n trov ersy regard in g the best tech­ Carotid Artery Balloon Test O cclusion: nique for arterial balloon test occlu­ sion (BTO) is rivaled only by that regard­ Combined C lin ica l Evaluation and ing the necessity for bypass grafting when apparent tolerance for arterial occlusion Xenon-enhanced Computed Tom ographic has been demonstrated. As previously re­ ported, the method for xenon-enhanced Cerebral Blood Flow Evaluation without computed tomographic (CT) cerebral blood flow (CBF) evaluation combined Patient Transfer or Balloon Reinflation: with BTO has consisted of an initial bal­ loon inflation of 15-minute duration (if Technical Note clinically tolerated), transfer of the patient from the angiography table to the CT scanner (with the deflated balloon re­ John D. Barr, M.D., Thomas J. Lemley, M.P.A.S., P.A.-C., maining in the carotid artery), and rein­ Richard M. McCann, R.T.(R.) (C.V.) flation of the balloon (without fluoro­ scopic visualization) for approximately 10 Departments of R ad io lo gy (JDB, T)L, RMM) and Surgery (JDB, TJL), Pennsylvania State minutes during CBF evaluation (2, 4, 6). University, Milton S. Hershey M edical Center, Hershey, Pennsylvania Criticisms of this technique have included the necessity for two balloon inflations O B JE C T IV E : C lin ical evaluation was combined with xenon-enhanced com ­ (especially the second blind inflation), pa­ tient transportation with a deflated bal­ puted tomographic (CT) cerebral blood flow (CBF) evaluation during loon positioned within the carotid artery, carotid artery balloon test occlusion (BTO ), without patient transfer from and the relatively brief, 15-minute, clinical the angiography suite to the C T scanner or balloon reinflation. neurological evaluation. We have as­ T E C H N IQ U E : Thirteen patients underwent carotid artery BTO. Placement of sessed the feasibility of performing the temporary occlusion balloons...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199809000-00144
Publisher site
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Abstract

AbstractOBJECTIVE:Clinical evaluation was combined with xenon-enhanced computed tomographic (CT) cerebral blood flow (CBF) evaluation during carotid artery balloon test occlusion (BTO), without patient transfer from the angiography suite to the CT scanner or balloon reinflation.TECHNIQUE:Thirteen patients underwent carotid artery BTO. Placement of temporary occlusion balloons was performed with patients positioned on the CT scanner table. If neurological testing revealed no changes within 10 minutes after balloon inflation, patients were positioned within the CT scanner gantry for xenon-enhanced CT CBF evaluation. CBF evaluations were begun 12 to 15 minutes after balloon inflation and required 8 minutes for completion. After completion of CBF evaluation, neurological testing continued during 30 minutes of arterial occlusion.RESULTS:One patient did not tolerate BTO, with the development of reversible hemiparesis. Reliable CBF data were not obtained because of patient motion in one case. Eleven patients clinically tolerated BTO and completed CBF evaluation. For five patients, xenon-enhanced CT scanning revealed no regions with CBF of less than 30 ml/100 g/min. For four patients, xenon-enhanced CT scanning revealed small regions with CBF of less than 30 ml/100 g/min within the anterior frontal lobe on the occluded side. For two patients, ipsilateral CBF decreased dramatically during BTO, with CBF in many regions of less than 30 ml/100 g/min and in some of less than 20 ml/100 g/min.CONCLUSION:Xenon-enhanced CT CBF evaluation can be combined with clinical testing during BTO without patient transfer, balloon reinflation, or increases in the duration of the procedure. We recognize that the value of CBF evaluation during BTO remains to be proven; our technique does, however, eliminate abbreviated clinical neurological evaluation, patient transfer, and balloon reinflation, which were previously associated with the use of xenon-enhanced CT CBF evaluation during carotid artery BTO.

Journal

NeurosurgeryOxford University Press

Published: Sep 1, 1998

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