Heparin was reversed using protamine sulfate before the sheath was withdrawn. Follow-up intracranial angiography through the guide catheter was performed after deflation of the balloon to rule out ischemic complications. Selective angiography of the ICA and external carotid artery of the opposite side, the common carotid artery of the tested side and the unilateral vertebral artery was performed after aortography in a subset of patients. About 30 mL of iodine contrast medium was injected at an injection speed of 10 mL/s for aortography. After ICA test occlusion, aortography was performed with a 4-Fr pigtail catheter to assess the venous phase delay between the occluded hemisphere and the contralateral hemisphere. The ICA was occluded for up to 20 min or more. In the presence of a change in neurologic status, the balloon was immediately deflated, and the procedure was terminated. The patient underwent a continuous neurologic evaluation throughout the examination. After inflation of the balloon, complete occlusion was confirmed by angiography. A balloon catheter (HyperForm 7 × 7 mm ev3, Medtronic, Santa Rosa, CA, USA) was advanced through the guide catheter into the petrous portion of the tested ICA. After diagnostic angiography of both the ICA and the unilateral vertebral artery, a 5-Fr guide catheter was placed into the ICA of the test occlusion. Intravenous heparin was administered to maintain an activated clotting time greater than 250 s during the procedure. A 5-Fr sheath was placed in the right common femoral artery, and a 4-Fr sheath was placed in the right radial artery. The relationship between the BTO results obtained in 104 ICAs and the MRA findings obtained in 96 patients were retrospectively evaluated.īalloon test occlusion was performed using Allura Xper (Philips Healthcare, Best, The Netherlands) under local anesthesia without sedation. Of these patients, 62 underwent preoperative BTO for invasive pituitary adenomas, 20 underwent BTO for ICA aneurysms, nine underwent BTO for parasellar meningiomas, and five underwent BTO for parasellar tumors. Twenty-six men and 70 women were included, with an age range of 19–90 years (median 57 years). However, this patient was included because the clinical results of BTO were obtained after ICA sacrifice. One patient underwent BTO and then subsequent ICA sacrifice under general anesthesia. In addition, eight patients underwent BTO of both ICAs. Therefore, 96 cases were included in this study. However, three of these 99 patients were excluded because the ICA was still occluded by tumor invasion in one patient, one patient had moyamoya disease, and the BTO procedure was terminated due to ICA spasm in the remaining patient. Between January 2011 and March 2017, 99 patients underwent BTO at Toranomon Hospital. This retrospective study was approved by the Institutional Review Board of Toranomon Hospital (No. The BTO prediction score is useful for predicting results of BTO. In conclusion, a thick ACC or a thin ACC with a thick PCC indicates BTO-tolerance. A sum of 3 points in the ACC and PCC indicated that all sides were BTO-tolerant. Thick, thin, and invisible ACCs were assigned 3, 1, and 0 points, respectively and thick, thin, and invisible PCCs were assigned 2, 1, and 0 points, respectively. Among these 33 tested sides, outcomes other than tolerance were observed regardless of PCC thickness. Among cases with an invisible ACC, 10 of 33 tested sides were BTO-tolerant (30.3%). Of these 44 tested sides, all five with a thick PCC were BTO-tolerant, but eight with a thin PCC and 31 with an invisible PCC showed results other than tolerance. In 31 of 44 cases with a thin ACC, the tested sides were BTO-tolerant (70.5%). BTO was tolerated in all 27 sides with thick ACC regardless of PCC thickness. On MRA, anterior cerebral artery (A1)–anterior communicating artery–A1 was defined as anterior collateral circulation (ACC), and posterior cerebral artery–posterior communicating artery was defined as posterior collateral circulation (PCC). The relationship between the BTO results for 104 internal carotid arteries and the MRA findings obtained in 96 patients were retrospectively evaluated. This retrospective study, included 96 patients who underwent BTO, eight of whom underwent bilateral BTO. We investigated whether magnetic resonance angiography (MRA) findings could predict BTO results to thus avoid the use of precautious BTO. Precautious balloon test occlusion (BTO) is sometimes performed in cases of high-risk intraoperative internal carotid artery injury.
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