FAILURE OF THE HYPOTENSIVE PROVOCATIVE TEST DURING TEMPORARY BALLOON TEST OCCLUSION OF THE INTERNAL CAROTID-ARTERY TO PREDICT DELAYED HEMODYNAMIC ISCHEMIA AFTER THERAPEUTIC CAROTID OCCLUSION

BACKGROUND Extensive experience and critical evaluation of the efficac y of a pharmacologic hypotensive challenge during conventional balloon test occlusion (BTO) of the internal carotid artery (ICA) is lacking. This prompted us to review our institution's most recent experience w ith this adjunctive provocative test before planned therapeutic balloo n occlusion of the ICA. METHODS Twenty consecutive cases of endovascul ar therapeutic balloon occlusion of the ICA were retrospectively revie wed. Conventional BTO under normotension and with hypotensive challeng e were performed within a standardized protocol. RESULTS Sixteen patie nts underwent provocative testing, of which 13 had BTO with hypotensiv e challenge. All patients in this group tolerated these maneuvers with out acute neurologic deficit. Two (15%) of these patients developed de layed permanent neurologic deficits, which seemed to be attributable t o hemodynamic ischemia. One of seven patients not undergoing hypotensi ve challenge also developed transient neurologic deficits after caroti d occlusion. CONCLUSIONS Despite the conceptually attractive and early positive experience of the hypotensive challenge in attempting to inc rease sensitivity and specificity of risk for developing delayed hemod ynamic ischemia, we have found two significant false-negative results. This experience is reviewed in the context of risks of permanent ball oon occlusion of the carotid artery after balloon test occlusion. (C) 1998 by Elsevier Science Inc.