Ischemic Tolerance Evaluated by Computed Tomography Perfusion during Balloon Test Occlusion

J Stroke Cerebrovasc Dis. 2020 Jun;29(6):104807. doi: 10.1016/j.jstrokecerebrovasdis.2020.104807. Epub 2020 Apr 13.


Objectives: Balloon test occlusion (BTO) is performed to evaluate ischemic tolerance for large and giant cerebral aneurysms and head and neck tumors that may require parent artery occlusion. However, ischemic tolerance for the temporary test occlusion does not always guarantee a tolerance for permanent occlusion. In this study, we evaluated the utility of computed tomography (CT) perfusion during BTO to quantify ischemic tolerance for detecting delayed ischemic stroke.

Materials and methods: Forty-one patients who underwent BTO for the internal carotid artery were included. The correlations between the parameters of CT perfusion and collateral angiographic appearance or stump pressure during BTO were evaluated. The cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT), and time to peak (TTP) were obtained through CT perfusion, and the asymmetry ratios were determined. Collateral angiographic appearances were categorized into 5 grades (0-4).

Results: The collateral angiographic appearance showed moderate correlations with CBF, MTT, and TTP that was significant. Of these, the absolute value of the correlation coefficient was the highest for MTT. MTT also showed a moderate correlation with stump pressure. CBF and MTT were significantly different between the poor collateral group (grades 2 and 3) and the good collateral group (grade 4). Based on the MTT, the good collateral group was identified with high sensitivity (75.0%) and specificity (81.2%).

Conclusions: In BTO, the MTT obtained through CT perfusion showed a correlation with collateral angiographic appearance and stump pressure. Thus, the MTT might be useful to quantify ischemic tolerance for detecting delayed ischemic stroke.

Keywords: Balloon test occlusion; cerebral blood flow; computed tomography perfusion; mean transit time; stump pressure.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Balloon Occlusion*
  • Blood Flow Velocity
  • Brain Ischemia / diagnostic imaging*
  • Brain Ischemia / physiopathology
  • Carotid Artery, Internal / diagnostic imaging*
  • Carotid Artery, Internal / physiopathology
  • Cerebral Angiography*
  • Cerebrovascular Circulation*
  • Child
  • Collateral Circulation*
  • Computed Tomography Angiography*
  • Female
  • Humans
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / physiopathology
  • Male
  • Middle Aged
  • Perfusion Imaging / methods*
  • Predictive Value of Tests
  • Retrospective Studies
  • Young Adult