Abstract
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.
Key Words
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Article info
Publication history
Published online: April 12, 2020
Accepted:
March 4,
2020
Received in revised form:
February 21,
2020
Received:
December 18,
2019
Footnotes
Disclosures: None.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104807
Copyright
© 2020 Elsevier Inc. All rights reserved.
