PREDICTIVE VALUE OF BALLOON TEST OCCLUSION OF THE INTERNAL CAROTID-ARTERY

Balloon test occlusion (BTO) of the internal carotid artery (ICA) is u sed in conjunction with single-photon emission computed tomography (SP ECT) imaging to assess the cerebrovascular collateral reserve prior to surgical manipulation of the artery. The present report reviews 56 co nsecutive patients with tumors or vascular lesions at the base of the skull who underwent BTO and subsequent treatment on that basis within a 3-year period. Four patients underwent carotid sacrifice, since they tolerated the BTO and had normal SPECT imaging. Postoperatively, one patient had patchy infarcts in the frontal lobe, another a middle cere bral artery territory infarction, a third had a lacunar infarct, and t he fourth had an impending stroke and was treated with an emergent rev ascularization procedure. There were 15 patients who underwent sapheno us vein bypass grafting, of these there were three graft occlusions, o ne of which resulted in an infarction. There were two other infarction s due to technical difficulties, one being related to the revasculariz ation procedure. Based on these results, we suggest that passing BTO w ith a normal SPECT study does not necessarily indicate that the patien t is immune is stroke following carotid sacrifice. Revascularization s hould be considered, when ICA sacrifice is deemed necessary to treat t he pathologic condition adequately, to minimize the likelihood of a st roke.