| Failure of the hypotensive provocative test during temporary balloon test occlusion of the internal carotid artery to predict delayed hemodynamic ischemia after therapeutic carotid occlusion. | |
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MedLine Citation:
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PMID: 9701120 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Extensive experience and critical evaluation of the efficacy of a pharmacologic hypotensive challenge during conventional balloon test occlusion (BTO) of the internal carotid artery (ICA) is lacking. This prompted us to review our institution's most recent experience with this adjunctive provocative test before planned therapeutic balloon occlusion of the ICA. METHODS: Twenty consecutive cases of endovascular therapeutic balloon occlusion of the ICA were retrospectively reviewed. Conventional BTO under normotension and with hypotensive challenge were performed within a standardized protocol. RESULTS: Sixteen patients underwent provocative testing, of which 13 had BTO with hypotensive challenge. All patients in this group tolerated these maneuvers without acute neurologic deficit. Two (15%) of these patients developed delayed permanent neurologic deficits, which seemed to be attributable to hemodynamic ischemia. One of seven patients not undergoing hypotensive challenge also developed transient neurologic deficits after carotid occlusion. CONCLUSIONS: Despite the conceptually attractive and early positive experience of the hypotensive challenge in attempting to increase sensitivity and specificity of risk for developing delayed hemodynamic ischemia, we have found two significant false-negative results. This experience is reviewed in the context of risks of permanent balloon occlusion of the carotid artery after balloon test occlusion. |
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Authors:
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A O Dare; J C Chaloupka; C M Putman; P B Fayad; I A Awad |
Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Surgical neurology Volume: 50 ISSN: 0090-3019 ISO Abbreviation: Surg Neurol Publication Date: 1998 Aug |
Date Detail:
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Created Date: 1998-08-27 Completed Date: 1998-08-27 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0367070 Medline TA: Surg Neurol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 147-55; discussion 155-6 Citation Subset: IM |
Affiliation:
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Interventional Neuroradiology Service, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8042, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Balloon Dilatation / methods* Brain / blood supply* Brain Ischemia / diagnosis* Carotid Artery Diseases / diagnosis Carotid Artery, Internal / radiography* Cerebral Angiography / methods Child Child, Preschool Female Humans Intracranial Hypotension / diagnosis* Male Middle Aged Prognosis Radiopharmaceuticals / diagnostic use Regional Blood Flow Retrospective Studies Technetium Tc 99m Exametazime / diagnostic use Time Factors Tomography, Emission-Computed, Single-Photon Tomography, X-Ray Computed |
| Chemical | |
Reg. No./Substance:
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0/Radiopharmaceuticals; 100504-35-6/Technetium Tc 99m Exametazime |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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