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AJNR - American Journal of Neuroradiology

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Venous Phase Timing during Balloon Test Occlusion as a Criterion for Permanent Internal Carotid Artery Sacrifice

Daniel Giansante Abud, Laurent Spelle, Michel Piotin, Charbel Mounayer, Jose Ricardo Vanzin and Jacques Moret

From the Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France

View larger version (156K): [in a new window]   FIG 1. Angiogram AP view demonstrates a right carotid occlusion test in a 42-year-old woman with large ICA aneurysm. A and B, Late arterial phase demonstrates excellent cross-filling by Acom. C, Early venous phase—1 second after second image—shows the beginning of venous phase in both sides (black arrows). D, One second later, the venous phase synchronous becomes more evident in both hemispheres (black arrows). This patient represents an example of perfect symmetry of venous phase delay during BTO.

View larger version (152K): [in a new window]   FIG 2. Angiographic AP view demonstrates a right carotid occlusion test in a 45-year-old man with a large cervical tumor. A, Late arterial phase demonstrates excellent cross-filling through Acom. B, One second after the previous image, beginning of venous phase on the left side (white arrow) and still some cortical arteries in the right hemisphere (indicated as 0 seconds). C, One second later, there are still cortical arteries on right side and veins on the left side (white arrow). D, One second later (ie, venous phase on 2 seconds) shows the veins filled in both hemispheres (black arrow on the right side and white arrow on the left side). This patient had a 2-second venous drainage delay, and permanent occlusion was performed at the same time.

View larger version (209K): [in a new window]   FIG 3. A 15-year-old girl test occlusion for a right giant ICA aneurysm. A, Angiogram AP view, injected by left ICA shows late arterial phase. B and C, Early and late venous phases, respectively, demonstrate perfect synchronous venous filling of left hemisphere and territory of right anterior cerebral artery through Acom. D, Arterial phase of the injection through left vertebral artery, AP view, demonstrates excellent cross-filling through Pcom. E and F, Early and late venous phases, respectively, show symmetry of venous filling of vertebrobasilar territory and right MCA territory through the right Pcom. This patient presented a supply of the right internal carotid artery territory via both Acom and Pcom, without venous delay. ICA permanent occlusion was performed at the same time.