BALLOON TEST OCCLUSION OF THE INTERNAL CA ROTID-ARTERY WITH EXTENSIVEHEMODYNAMIC MONITORING FOR EVALUATION OF STROKE RISK PRIOR TO THERAPEUTIC CAROTID OCCLUSION

Purpose: To evaluate stroke risk assessment of balloon test occlusion of the internal carotid artery (ICA) with enlarged haemodynamic monito ring prior to permanent ICA occlusion. Material and methods: 24 patien ts with cervical metastasis (n = 18), cavernous meningiomas (n = 3) or inoperable cavernous aneurysms (n = 3) were examined. The test occlus ion was monitored by EEG, neurological examinations and transcranial D oppler sonography of the ipsilateral middle cerebral artery with evalu ation of the cerebrovascular reserve capacity. Additionally Tc-99m-HMP AO-SPECT imaging was added showing the perfusion during test occlusion . Results: In one (4 %) patient the test occlusion had to be interrupt ed previously due to an acute neurological deficit. This patient and t wo (8 %) patients with highly pathological test results in SPECT and T CD were excluded from permanent carotid occlusion. In 6 (25 %) patient s 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 p redicted by this procedure. Conclusions: The multimodal balloon test o cclusion with enlarged haemodynamic monitoring allows haemodynamic str oke risk assessment prior to permanent occlusion of the ICA.