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Monitoring of Balloon Test Occlusion of the Internal Carotid Artery by Parametric Color Coding and Perfusion Imaging Within the Angio Suite: First Results

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Abstract

Background

Temporary balloon test occlusion (BTO) might be performed prior to procedures in which occlusion of the internal carotid artery (ICA) might be necessary. We tested the hypothesis that parametric color coding (PCC) of angiographic series (digital subtraction angiography (DSA)) along with the assessment of cerebral blood volume (CBV) in the angiography suite would simplify and enhance the identification of candidates who are most likely to tolerate occlusion.

Materials and Methods

Fifteen patients underwent angiographic series (DSA) and perfusion imaging before and during BTO. Pre- and postocclusion DSA acquisitions were evaluated for venous delay by conventional methods (“eye balling”) and by PCC measurements. Comparison of CBV values between the left and right hemisphere in 6 defined regions was performed.

Results

Values of venous delay by eye balling and PCC showed a high correlation (r = 0.87, p < 0.01). Bland–Altman plot indicated slightly lower values (− 0.05 s) by the PCC method. One of the 15 patients developed an asymmetrical CBV map with an increase in CBV of more than one standard deviation in 3 of the 6 regions of interest (ROIs). Acquisition of angiographic series and perfusion imaging did not prolong the test occlusion time.

Conclusion

PCC and CBV mapping are feasible during BTO. The use of PCC seems to simplify the ability to measure changes in venous filling delay. Perfusion imaging may show an increase in CBV in patients reaching the limits of cerebral autoregulation. These patients may be at risk for delayed infarction, even though they seem to tolerate temporary occlusion, and could be unsuitable candidates for permanent ICA occlusion.

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Conflict of Interest

Yu Deuerling-Zheng is a full-time employee of Siemens AG, Healthcare Sector. All other authors declare that there are no actual or potential conflict of interests in relation to this article.

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Authors and Affiliations

  1. Department of Neuroradiology, University of Erlangen-Nuermberg, Schwabachanlage 6, 91054, Erlangen, Germany

    T. Struffert MD, T. Engelhorn MD, S. Kloska MD, P. Gölitz MD & A. Doerfler MD, PhD

  2. Healthcare Sector, Siemens AG, Siemensstrasse 1, 91301, Forchheim, Germany

    Y. Deuerling-Zheng

  3. Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuermberg, Schwabachanlage 6, 91054, Erlangen, Germany

    A. Bozzato MD & M. Kapsreiter MD

  4. Department of Radiology, University of Wisconsin, 600 Highland Avenue Mail Code 3252, 53792–3252, Madison, WI, USA

    C. M. Strother MD, PhD

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  1. T. Struffert MD
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Correspondence to T. Struffert MD.

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Struffert, T., Deuerling-Zheng, Y., Engelhorn, T. et al. Monitoring of Balloon Test Occlusion of the Internal Carotid Artery by Parametric Color Coding and Perfusion Imaging Within the Angio Suite: First Results. Clin Neuroradiol 23, 285–292 (2013). https://doi.org/10.1007/s00062-013-0208-z

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