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Review
. 2014 Feb;27(1):115-9.
doi: 10.15274/NRJ-2014-10014. Epub 2014 Feb 24.

Monitoring balloon test occlusion of the internal carotid artery with transcranial Doppler. A case report and literature review

Orlando Galego  1 , César Nunes  2 , Ricardo Morais  2 , João Sargento-Freitas  3 , Francisco Sales  3 , Egídio Machado  2
Affiliations
Review

Monitoring balloon test occlusion of the internal carotid artery with transcranial Doppler. A case report and literature review

Orlando Galego et al. Neuroradiol J. 2014 Feb.

Abstract

Angiographic balloon test occlusion (BTO) allows preoperative risk evaluation of patients undergoing permanent therapeutic occlusion of the internal carotid artery (ICA). The sensitivity of the BTO can be increased using different complementary techniques. Transcranial Doppler (TCD) stands out as a non-invasive, bedside method providing real-time monitoring of cerebral haemodynamics, therefore accurately identifying patients at risk of stroke. A case of a 30-year-old woman with a giant intracavernous aneurysm of the left ICA presenting with subacute left VI nerve palsy is described. A pre-operative TCD- and EEG-monitored BTO of the left ICA was performed. The 16.7% drop found in the middle cerebral artery's peak systolic velocity (PSVMCA) predicts clinical and haemodynamic tolerance to the permanent loss of that vessel. This case illustrates the potential of TCD monitoring during temporary BTO of the ICA. It highlights its ability to provide a complete preclinical evaluation of collateralization and autoregulatory adaptation to unilateral ICA occlusion. TCD may also decrease the time of occlusion required for the BTO.

Keywords: balloon test occlusion; giant aneurysm; internal carotid; transcranial Doppler ultrasonography.

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Figures

Figure 1
Figure 1
Giant aneurysm of the left internal carotid artery, involving its intracavernous segment (arrows). A) Contrast-enhanced CT. B) Digital subtraction angiography.
Figure 2
Figure 2
TCD evaluation during ICA occlusion shows collateralization through the anterior communicating artery (AcomA). Note the absence of a posterior communicating artery contribution. ACA - anterior cerebral artery; MCA - middle cerebral artery.
Figure 3
Figure 3
Angle corrected left middle cerebral artery flow variation registered by transcranial Doppler during the procedure. A) Before left ICA occlusion. B) During ICA occlusion. C) After balloon deflation. Note the documented 16.7% decrease of the peak systolic velocity of the middle cerebral artery (PSV), inferior to the 30% threshold.
Figure 4
Figure 4
Events following occlusion of a major cerebral artery, according to the decrease in brain tissue perfusion. Note how haemodynamic disturbances are immediate and can be detected with transcranial Doppler.
See this image and copyright information in PMC

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