Skip to main content
Top
Published in: Clinical Neuroradiology 4/2015

01-12-2015 | Original Research

The Value of syngo DynaPBV Neuro During Neuro-Interventional Hypotensive Balloon Occlusion Test

Authors: M. Yang, J. Wu, L. Ma, L. Pan, J. Li, G. Chen, T. Struffert, Q. Sun, J. Beilner, Y. Deuerling-Zheng

Published in: Clinical Neuroradiology | Issue 4/2015

Login to get access

Abstract

Aim

This study explored the value of flat detector computed tomography based brain perfusion imaging in assessing patient’s tolerance prior to the permanent internal carotid artery occlusion.

Materials and Methods

Ten patients diagnosed with neurovascular diseases through digital subtracted angiography (DSA) were enrolled into this study. Temporary balloon occlusion test (BOT) was performed for each patient with hypotensive challenge. During the test, parametric color-coded quantitative DSA (CCQ-DSA) was generated to evaluate the venous filling symmetry on both hemispheres. In addition, cerebral blood volume (CBV) maps were acquired before and during the test. Regions of interests were defined to quantitatively extract CBV value from affected and unaffected hemispheres and calculate relative CBV (rCBV), indicating perfusion symmetry.

Results

All the patients showed good perfusion symmetry before the test with rCBV close to 1.00. During the test, good perfusion symmetry was detected in 7 patients with averaged rCBV 1.03 ± 0.06. Only short venous delay and no ischemic complications were recognized. One patient had neither neurologic deficits nor long venous delay detected, however, showed hyper-perfusion in specific regions in the CBV maps. Two patients failed to pass the test, which showed significantly low CBV value from the affected hemisphere with maximum rCBV reduction close to 45 %.

Conclusion

CBV map had in general good consistency with clinical manifestations as well as venous filling in the BOT. Besides, it may provide further evidence of hemodynamic variations and delayed ischemic complications, and thus, had a potential to reduce risks and increase treatment safety.
Literature
1.
go back to reference Elhammady MS, Wolfe SQ, Farhat H, Ali Aziz-Sultan M, Heros RC. Carotid artery sacrifice for unclippable and uncoilable aneurysms: endovascular occlusion vs common carotid artery ligation. Neurosurgery. 2010;67(5):1431–7.CrossRefPubMed Elhammady MS, Wolfe SQ, Farhat H, Ali Aziz-Sultan M, Heros RC. Carotid artery sacrifice for unclippable and uncoilable aneurysms: endovascular occlusion vs common carotid artery ligation. Neurosurgery. 2010;67(5):1431–7.CrossRefPubMed
2.
go back to reference Meyersa PM, Thakura GA, Tomsicka TA. Temporary endovascular balloon occlusion of the internal carotid artery with a nondetachable silicone balloon catheter: analysis of technique and cost. AJNR Am J Neuroradiol. 1999;20:559–64. Meyersa PM, Thakura GA, Tomsicka TA. Temporary endovascular balloon occlusion of the internal carotid artery with a nondetachable silicone balloon catheter: analysis of technique and cost. AJNR Am J Neuroradiol. 1999;20:559–64.
3.
go back to reference Schorstein J. Carotid ligation in saccular intracranial aneurysms. Br J Surg. 1994;28:50–70.CrossRef Schorstein J. Carotid ligation in saccular intracranial aneurysms. Br J Surg. 1994;28:50–70.CrossRef
4.
go back to reference Olivecrona H. Ligature of the carotid artery in intracranial aneurysms. Acta Chir Scand. 1944;91:353–68. Olivecrona H. Ligature of the carotid artery in intracranial aneurysms. Acta Chir Scand. 1944;91:353–68.
5.
6.
go back to reference Moore OS, Baker HW. Carotid artery ligation in surgery of the head and neck. Cancer. 1955;8:712–26.CrossRefPubMed Moore OS, Baker HW. Carotid artery ligation in surgery of the head and neck. Cancer. 1955;8:712–26.CrossRefPubMed
7.
go back to reference Moore OS, Karlan M, Sigler L. Factors influencing the safety of carotid ligation. Am J Surg. 1969;118:666–8.CrossRefPubMed Moore OS, Karlan M, Sigler L. Factors influencing the safety of carotid ligation. Am J Surg. 1969;118:666–8.CrossRefPubMed
8.
go back to reference Linskey ME, Jungreis CA, Yonas H, Hirsch WL Jr, Sekhar LN, Horton JA, Janosky JE. Stroke risk after abrupt internal carotid artery occlusion and stable xenon-enhanced CT. AJNR Am J Neuroradiol. 1994;15:829–43.PubMed Linskey ME, Jungreis CA, Yonas H, Hirsch WL Jr, Sekhar LN, Horton JA, Janosky JE. Stroke risk after abrupt internal carotid artery occlusion and stable xenon-enhanced CT. AJNR Am J Neuroradiol. 1994;15:829–43.PubMed
9.
go back to reference Brunberg JA, Frey KA, Horton JA, Deveikis JP, Ross DA, Koeppe RA. [15O] H2O positron emission tomography determination of cerebral blood flow during balloon test occlusion of the internal carotid artery. AJNR Am J Neuroradiol. 1994;15:725–32.PubMed Brunberg JA, Frey KA, Horton JA, Deveikis JP, Ross DA, Koeppe RA. [15O] H2O positron emission tomography determination of cerebral blood flow during balloon test occlusion of the internal carotid artery. AJNR Am J Neuroradiol. 1994;15:725–32.PubMed
10.
go back to reference Van der Schaaf IC, Brilstra EH, Buskens E, Rinkel GJ. Endovascular treatment of aneurysms in the cavernous sinus: a systematic review on balloon occlusion of the parent vessel and embolization with coils. Stroke. 2002;33(1):313–8.CrossRef Van der Schaaf IC, Brilstra EH, Buskens E, Rinkel GJ. Endovascular treatment of aneurysms in the cavernous sinus: a systematic review on balloon occlusion of the parent vessel and embolization with coils. Stroke. 2002;33(1):313–8.CrossRef
11.
go back to reference Sanna M, Piazza P, Ditrapani G, Agarwal M. Management of the internal carotid artery in tumors of the lateral skull base: preoperative permanent balloon occlusion without reconstruction. Otol Neurotol. 2004;25:998–1005.CrossRefPubMed Sanna M, Piazza P, Ditrapani G, Agarwal M. Management of the internal carotid artery in tumors of the lateral skull base: preoperative permanent balloon occlusion without reconstruction. Otol Neurotol. 2004;25:998–1005.CrossRefPubMed
12.
go back to reference van Rooij WJ, Sluzewski M, Slob MJ, Rinkel GJ. Predictive value of angiographic testing for tolerance to therapeutic occlusion of the carotid artery. AJNR Am J Neuroradiol. 2005;26:175–8.PubMed van Rooij WJ, Sluzewski M, Slob MJ, Rinkel GJ. Predictive value of angiographic testing for tolerance to therapeutic occlusion of the carotid artery. AJNR Am J Neuroradiol. 2005;26:175–8.PubMed
13.
go back to reference Abud DG, Spelle L, Piotin M, Mounayer C, Vanzin JR, Moret J. Venous phase timing during balloon test occlusion as a criterion. AJNR Am J Neuroradiol. 2005;26:2602–9.PubMed Abud DG, Spelle L, Piotin M, Mounayer C, Vanzin JR, Moret J. Venous phase timing during balloon test occlusion as a criterion. AJNR Am J Neuroradiol. 2005;26:2602–9.PubMed
14.
go back to reference Struffert T, Deuerling-Zheng Y, Engelhorn T, Kloska S, Gölitz P, Bozzato A, Kapsreiter M, Strother CM, Doerfler A. 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. 2013;23(4):285–92.CrossRefPubMed Struffert T, Deuerling-Zheng Y, Engelhorn T, Kloska S, Gölitz P, Bozzato A, Kapsreiter M, Strother CM, Doerfler A. 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. 2013;23(4):285–92.CrossRefPubMed
15.
go back to reference Ahmed AS, Zellerhoff M, Strother CM, Pulfer K, Redel T, Deuerling-Zheng Y, Royalty K, Consigny D, Niemann DB. C-arm CT measurement of cerebral blood volume: an experimental study in canines. AJNR Am J Neuroradiol. 2009;30:917–22.CrossRefPubMed Ahmed AS, Zellerhoff M, Strother CM, Pulfer K, Redel T, Deuerling-Zheng Y, Royalty K, Consigny D, Niemann DB. C-arm CT measurement of cerebral blood volume: an experimental study in canines. AJNR Am J Neuroradiol. 2009;30:917–22.CrossRefPubMed
16.
go back to reference Bley T, Strother CM, Pulfer K, Zellerhoff M, Deuerling-Zheng Y, Bender F, Consigny D, Yasuda R, Niemann D. C-arm CT measurement of cerebral blood volume in ischemic stroke: an experimental study in canines. AJNR Am J Neuroradiol. 2010;31:536–40.CrossRefPubMed Bley T, Strother CM, Pulfer K, Zellerhoff M, Deuerling-Zheng Y, Bender F, Consigny D, Yasuda R, Niemann D. C-arm CT measurement of cerebral blood volume in ischemic stroke: an experimental study in canines. AJNR Am J Neuroradiol. 2010;31:536–40.CrossRefPubMed
17.
go back to reference Struffert T, Deuerling-Zheng Y, Kloska S, Engelhorn T, Strother CM, Kalender WA, Köhrmann M, Schwab S, Doerfler A. Flat detector CT in the evaluation of brain parenchyma, intracranial vasculature, and cerebral blood volume: a pilot study in patients with acute symptoms of cerebral ischemia. AJNR Am J Neuroradiol. 2010;31(8):1462–9.CrossRefPubMed Struffert T, Deuerling-Zheng Y, Kloska S, Engelhorn T, Strother CM, Kalender WA, Köhrmann M, Schwab S, Doerfler A. Flat detector CT in the evaluation of brain parenchyma, intracranial vasculature, and cerebral blood volume: a pilot study in patients with acute symptoms of cerebral ischemia. AJNR Am J Neuroradiol. 2010;31(8):1462–9.CrossRefPubMed
18.
go back to reference Struffert T, Deuerling-Zheng Y, Engelhorn T, Kloska S, Gölitz P, Köhrmann M, Schwab S, Strother CM, Doerfler A. Feasibility of cerebral blood volume mapping by flat panel detector CT in the angiography suite: first experience in patients with acute middle cerebral artery occlusions. AJNR Am J Neuroradiol. 2012;33:618–25.CrossRefPubMed Struffert T, Deuerling-Zheng Y, Engelhorn T, Kloska S, Gölitz P, Köhrmann M, Schwab S, Strother CM, Doerfler A. Feasibility of cerebral blood volume mapping by flat panel detector CT in the angiography suite: first experience in patients with acute middle cerebral artery occlusions. AJNR Am J Neuroradiol. 2012;33:618–25.CrossRefPubMed
19.
go back to reference Standard SC, Ahuja A, Guterman LR, Chavis TD, Gibbons KJ, Barth AP, Hopkins LN. Balloon test occlusion of the internal carotid artery with hypotensive challenge. AJNR Am J Neuroradiol. 1995;16(7):1453–8.PubMed Standard SC, Ahuja A, Guterman LR, Chavis TD, Gibbons KJ, Barth AP, Hopkins LN. Balloon test occlusion of the internal carotid artery with hypotensive challenge. AJNR Am J Neuroradiol. 1995;16(7):1453–8.PubMed
20.
go back to reference Dare AO, Chaloupka JC, Putman CM, Fayad PB, Awad IA. Failure of the hypotensive provocative test during temporary balloon test occlusion of the internal carotid artery to predict delayed ischemic complications after therapeutic carotid occlusion. Surg Neurol. 1998;50(2):147–56.CrossRefPubMed Dare AO, Chaloupka JC, Putman CM, Fayad PB, Awad IA. Failure of the hypotensive provocative test during temporary balloon test occlusion of the internal carotid artery to predict delayed ischemic complications after therapeutic carotid occlusion. Surg Neurol. 1998;50(2):147–56.CrossRefPubMed
21.
go back to reference Cover KS, Lagerwaard FJ, van den Berg R, Buis DR, Slotman BJ. Color intensity projection of digitally subtracted angiography for the visualization of brain arteriovenous malformations. Neurosurg. 2007;60:511–5.CrossRef Cover KS, Lagerwaard FJ, van den Berg R, Buis DR, Slotman BJ. Color intensity projection of digitally subtracted angiography for the visualization of brain arteriovenous malformations. Neurosurg. 2007;60:511–5.CrossRef
22.
go back to reference Struffert T, Hauer M, Banckwitz R, Koehler C, Royalty K, Doerfler A. Effective dose to patient measurements in flat-detector and multislice computed tomography: a comparison of applications in neuroradiology. Eur Radiol. 2014;24(6):1257–65.CrossRefPubMed Struffert T, Hauer M, Banckwitz R, Koehler C, Royalty K, Doerfler A. Effective dose to patient measurements in flat-detector and multislice computed tomography: a comparison of applications in neuroradiology. Eur Radiol. 2014;24(6):1257–65.CrossRefPubMed
23.
go back to reference Sugawara Y, Kikuchi T, Ueda T, Nishizaki M, Nakata S, Mochizuki T, Ikezoe J. Usefulness of brain SPECT to evaluate brain tolerance and hemodynamic changes during temporary balloon occlusion test and after permanent carotid occlusion. J Nucl Med. 2002;43:1616–23.PubMed Sugawara Y, Kikuchi T, Ueda T, Nishizaki M, Nakata S, Mochizuki T, Ikezoe J. Usefulness of brain SPECT to evaluate brain tolerance and hemodynamic changes during temporary balloon occlusion test and after permanent carotid occlusion. J Nucl Med. 2002;43:1616–23.PubMed
Metadata
Title
The Value of syngo DynaPBV Neuro During Neuro-Interventional Hypotensive Balloon Occlusion Test
Authors
M. Yang
J. Wu
L. Ma
L. Pan
J. Li
G. Chen
T. Struffert
Q. Sun
J. Beilner
Y. Deuerling-Zheng
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 4/2015
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-014-0316-4

Other articles of this Issue 4/2015

Clinical Neuroradiology 4/2015 Go to the issue