Balloon test occlusion with hypotensive challenge for main trunk occlusion of internal carotid artery aneurysms and pseudoaneurysms

George Kwok Chu Wong, Wai Sang Poon & Simon Chun Ho Yu

Abstract

BACKGROUND:
Balloon test occlusion of carotid artery is a useful procedure in managing patients with internal carotid aneurysms and psuedoaneurysms. Previous studies using intravenous sodium nitroprusside for hypotensive challenge yielded false-negative results for haemodynamic ischaemia, highlighting the difference between pharmacological and compensatory vasodilatory responses. We reviewed our management result of a combined approach of clinical assessment and angiographic assessment of venous drainage using intravenous labetalol for hypotensive challenge.

METHODS:
A retrospective review of all balloon test occlusions carried in a single neurosurgical institute between August 1996 and August 2009 was carried out. Patients with internal carotid artery aneurysms and pseudoaneurysms were reviewed accordingly.

RESULTS:
The diagnosis at the time of treatment included radiotherapy-induced internal carotid artery pseudoaneurysms in nasopharyngeal carcinoma patients (11/23, 48%), cavernous internal carotid artery giant aneurysm (6/23, 26%) and ophthalmic segment internal carotid artery giant aneurysm (4/23, 17%). Nineteen (79%) patients passed the balloon test occlusion. In the cohort of patients that passed balloon test occlusion and underwent main trunk occlusion, there were no (0/20, 0%) permanent and no (0, 0%) transient neurological complications related to a subsequent parent artery occlusion.

CONCLUSIONS:
A combined approach of clinical assessment and angiographic assessment of venous drainage, using intravenous labetalol for hypotensive challenge, is effective in screening out patients who were at a risk for ischaemia after internal carotid artery occlusion and can serve as a guideline for the selection of patients requiring extracranial-intracranial bypass.

Abstract: http://www.bioportfolio.com/resources/pmarticle/5772/Balloon-Test-Occlusion-With-Hypotensive-Challenge-For-Main-Trunk-Occlusion-Of-Internal.html