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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1997 May;62(5):485–489. doi: 10.1136/jnnp.62.5.485

Preoperative risk assessment for carotid occlusion by transcranial Doppler ultrasound.

S Schneweis 1, H Urbach 1, L Solymosi 1, F Ries 1
PMCID: PMC486859  PMID: 9153606

Abstract

OBJECTIVES: An endovascular carotid balloon occlusion test with continuous intracranial monitoring by transcranial Doppler sonography was performed in 55 patients for prediction of tolerance of a required permanent occlusion of the carotid artery. METHODS: Blood flow velocities of the ipsilateral middle cerebral artery during occlusion were recorded and compared with clinical tolerance during an occlusion test as well as with postoperative outcome after an eventual permanent occlusion. To stress the capacity of the cerebral circulation to tolerate the occlusion acetazolamide was injected before occlusion in all patients. RESULTS: The onset of neurological symptoms during temporary occlusion was dependent on the percentage fall of mean blood flow velocity relative to baseline rather than on absolute flow velocities during the time of occlusion. Patients with a fall of mean flow velocity of less than 30% tolerated temporary and permanent occlusion, with the exception of two patients who developed an infarction due to thromboembolism after iatrogenic sacrifice of the carotid artery. Patients with a major decrease developed neurological symptoms during occlusion in 55% and, in cases of carotid ligation, a haemodynamic infarction occurred. CONCLUSION: The results show that transcranial Doppler monitoring as a part of an endovascular balloon occlusion test may be a reliable technique for preoperative risk assessment for permanent occlusion of the carotid artery.

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Selected References

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  1. Askienazy S., Lebtahi R., Meder J. F. SPECT HMPAO and balloon test occlusion: interest in predicting tolerance prior to permanent cerebral artery occlusion. J Nucl Med. 1993 Aug;34(8):1243–1245. [PubMed] [Google Scholar]
  2. Berenstein A., Ransohoff J., Kupersmith M., Flamm E., Graeb D. Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization. Surg Neurol. 1984 Jan;21(1):3–12. doi: 10.1016/0090-3019(84)90392-6. [DOI] [PubMed] [Google Scholar]
  3. Bishop C. C., Powell S., Rutt D., Browse N. L. Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study. Stroke. 1986 Sep-Oct;17(5):913–915. doi: 10.1161/01.str.17.5.913. [DOI] [PubMed] [Google Scholar]
  4. Brunberg J. A., Frey K. A., Horton J. A., Deveikis J. P., Ross D. A., Koeppe R. A. [15O]H2O positron emission tomography determination of cerebral blood flow during balloon test occlusion of the internal carotid artery. AJNR Am J Neuroradiol. 1994 Apr;15(4):725–732. [PMC free article] [PubMed] [Google Scholar]
  5. EHRENREICH D. L., BURNS R. A., ALMAN R. W., FAZEKAS J. F. Influence of acetazolamide on cerebral blood flow. Arch Neurol. 1961 Aug;5:227–232. doi: 10.1001/archneur.1961.00450140109011. [DOI] [PubMed] [Google Scholar]
  6. Gonzalez C. F., Moret J. Balloon occlusion of the carotid artery prior to surgery for neck tumors. AJNR Am J Neuroradiol. 1990 Jul-Aug;11(4):649–652. [PMC free article] [PubMed] [Google Scholar]
  7. Halsey J. H., McDowell H. A., Gelmon S., Morawetz R. B. Blood velocity in the middle cerebral artery and regional cerebral blood flow during carotid endarterectomy. Stroke. 1989 Jan;20(1):53–58. doi: 10.1161/01.str.20.1.53. [DOI] [PubMed] [Google Scholar]
  8. Keller E., Ries F., Grünwald F., Honisch C., Rosanowski F., Pavics L., Herberhold C., Solymosi L. Multimodaler Karotisokklusionstest zur Bestimmung des Infarktrisikos vor therapeutischem Karotis-interna-Verschluss. Laryngorhinootologie. 1995 May;74(5):307–311. doi: 10.1055/s-2007-997745. [DOI] [PubMed] [Google Scholar]
  9. Kofke W. A., Brauer P., Policare R., Penthany S., Barker D., Horton J. Middle cerebral artery blood flow velocity and stable xenon-enhanced computed tomographic blood flow during balloon test occlusion of the internal carotid artery. Stroke. 1995 Sep;26(9):1603–1606. doi: 10.1161/01.str.26.9.1603. [DOI] [PubMed] [Google Scholar]
  10. Leech P. J., Miller J. D., Fitch W., Barker J. Cerebral blood flow, internal carotid artery pressure, and the EEG as a guide to the safety of carotid ligation. J Neurol Neurosurg Psychiatry. 1974 Jul;37(7):854–862. doi: 10.1136/jnnp.37.7.854. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Linskey M. E., Jungreis C. A., Yonas H., Hirsch W. L., Jr, Sekhar L. N., Horton J. A., Janosky J. E. Stroke risk after abrupt internal carotid artery sacrifice: accuracy of preoperative assessment with balloon test occlusion and stable xenon-enhanced CT. AJNR Am J Neuroradiol. 1994 May;15(5):829–843. [PMC free article] [PubMed] [Google Scholar]
  12. Linskey M. E., Sekhar L. N., Horton J. A., Hirsch W. L., Jr, Yonas H. Aneurysms of the intracavernous carotid artery: a multidisciplinary approach to treatment. J Neurosurg. 1991 Oct;75(4):525–534. doi: 10.3171/jns.1991.75.4.0525. [DOI] [PubMed] [Google Scholar]
  13. Mathews D., Walker B. S., Purdy P. D., Batjer H., Allen B. C., Eckard D. A., Devous M. D., Sr, Bonte F. J. Brain blood flow SPECT in temporary balloon occlusion of carotid and intracerebral arteries. J Nucl Med. 1993 Aug;34(8):1239–1243. [PubMed] [Google Scholar]
  14. Monsein L. H., Jeffery P. J., van Heerden B. B., Szabo Z., Schwartz J. R., Camargo E. E., Chazaly J. Assessing adequacy of collateral circulation during balloon test occlusion of the internal carotid artery with 99mTc-HMPAO SPECT. AJNR Am J Neuroradiol. 1991 Nov-Dec;12(6):1045–1051. [PMC free article] [PubMed] [Google Scholar]
  15. Moody E. B., Dawson R. C., 3rd, Sandler M. P. 99mTc-HMPAO SPECT imaging in interventional neuroradiology: validation of balloon test occlusion. AJNR Am J Neuroradiol. 1991 Nov-Dec;12(6):1043–1044. [PMC free article] [PubMed] [Google Scholar]
  16. Morioka T., Matsushima T., Fujii K., Fukui M., Hasuo K., Hisashi K. Balloon test occlusion of the internal carotid artery with monitoring of compressed spectral arrays (CSAs) of electroencephalogram. Acta Neurochir (Wien) 1989;101(1-2):29–34. doi: 10.1007/BF01410065. [DOI] [PubMed] [Google Scholar]
  17. Nishioka H. Results of the treatment of intracranial aneurysms by occlusion of the carotid artery in the neck. J Neurosurg. 1966 Dec;25(6):660–704. doi: 10.3171/jns.1966.25.6.0660. [DOI] [PubMed] [Google Scholar]
  18. Palestro C. J., Sen C., Muzinic M., Afriyie M., Goldsmith S. J. Assessing collateral cerebral perfusion with technetium-99m-HMPAO SPECT during temporary internal carotid artery occlusion. J Nucl Med. 1993 Aug;34(8):1235–1238. [PubMed] [Google Scholar]
  19. Razack M. S., Sako K. Carotid artery hemorrhage and ligation in head and neck cancer. J Surg Oncol. 1982 Apr;19(4):189–192. doi: 10.1002/jso.2930190402. [DOI] [PubMed] [Google Scholar]
  20. Ringelstein E. B., Sievers C., Ecker S., Schneider P. A., Otis S. M. Noninvasive assessment of CO2-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusions. Stroke. 1988 Aug;19(8):963–969. doi: 10.1161/01.str.19.8.963. [DOI] [PubMed] [Google Scholar]
  21. Ringelstein E. B., Zeumer H., Schneider R. Der Beitrag der zerebralen Computertomographie zur Differentialtypologie und Differentialtherapie des ischämischen Grosshirninfarktes. Fortschr Neurol Psychiatr. 1985 Sep;53(9):315–336. doi: 10.1055/s-2007-1001976. [DOI] [PubMed] [Google Scholar]
  22. Trojaborg W., Boysen G. Relation between EEG, regional cerebral blood flow and internal carotid artery pressure during carotid endarterectomy. Electroencephalogr Clin Neurophysiol. 1973 Jan;34(1):61–69. doi: 10.1016/0013-4694(73)90151-x. [DOI] [PubMed] [Google Scholar]
  23. Vorstrup S., Brun B., Lassen N. A. Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke. 1986 Nov-Dec;17(6):1291–1298. doi: 10.1161/01.str.17.6.1291. [DOI] [PubMed] [Google Scholar]
  24. Witt J. P., Yonas H., Jungreis C. Cerebral blood flow response pattern during balloon test occlusion of the internal carotid artery. AJNR Am J Neuroradiol. 1994 May;15(5):847–856. [PMC free article] [PubMed] [Google Scholar]

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