Document Detail

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.
MedLine Citation:
PMID:  9701120     Owner:  NLM     Status:  MEDLINE    
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.
A O Dare; J C Chaloupka; C M Putman; P B Fayad; I A Awad
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Surgical neurology     Volume:  50     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  1998 Aug 
Date Detail:
Created Date:  1998-08-27     Completed Date:  1998-08-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  147-55; discussion 155-6     Citation Subset:  IM    
Interventional Neuroradiology Service, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8042, USA.
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MeSH Terms
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, Preschool
Intracranial Hypotension / diagnosis*
Middle Aged
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
Reg. No./Substance:
0/Radiopharmaceuticals; 100504-35-6/Technetium Tc 99m Exametazime

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