Angiographic Circulation Time and Cerebral Blood Flow during Balloon Test Occlusion of the Internal Carotid Artery

Angiography-based balloon test occlusion (BTO) has been empirically used to predict tolerance to permanent carotid artery occlusion. We tested the hypothesis that the laterality of the hemispheric circulation time (HCT) of the contrast medium at cerebral angiography would reflect bilateral asymmetry of the cerebral blood flow (CBF) during BTO. Thirty-one consecutive patients who underwent BTO of the internal carotid artery were retrospectively analyzed. HCT was defined as the interval between the time-to-peak in the middle cerebral artery and the cortical veins calculated using time-density curve. The difference in HCT between the occluded and nonoccluded side was calculated at the carotid or dominant vertebral angiograms obtained during BTO. We estimated the correlation between the difference in HCT and bilateral asymmetry of the CBF, which was quantitatively determined by single-photon emission computed tomography. The HCT was 5.3±1.5 seconds and regional CBF was 41.3±11.3 mL/100 g per minute in the occluded side, compared with 3.6±0.9 seconds and 48.4±14.9 mL/100 g per minute in the nonoccluded side, respectively. The difference in HCT was strongly correlated with the asymmetry ratio of the CBF ( r2=0.89, P<0.0001). Angiographically based measurement of the cerebral circulation time can provide valuable information concerning cerebral hemodynamics.

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Changes in cerebral blood flow induced by balloon test occlusion of the internal carotid artery under hypotension

European Journal of Nuclear Medicine ◽

10.1007/bf00801611 ◽

1995 ◽

Vol 22 (11) ◽

pp. 1268-1273 ◽

Cited By ~ 18

Author(s):

Fumiko Tanaka ◽

Sadahiko Nishizawa ◽

Yoshiharu Yonekura ◽

Norihiro Sadato ◽

Koichi Ishizu ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Balloon Test Occlusion

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Layering of contrast media in the internal carotid artery related to angiographic circulation time and cerebral blood flow

Neuroradiology ◽

10.1007/bf00399811 ◽

1973 ◽

Vol 6 (2) ◽

pp. 71-77 ◽

Cited By ~ 5

Author(s):

A. Debaene

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Contrast Media ◽

Internal Carotid ◽

Circulation Time

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Balloon Test Occlusion of the Internal Carotid Artery with Stable Xenon/CT Cerebral Blood Flow Imaging

Investigative Radiology ◽

10.1097/00004424-198907000-00015 ◽

1989 ◽

Vol 24 (7) ◽

pp. 578-579 ◽

Cited By ~ 1

Author(s):

D Gordon Potts

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Flow Imaging ◽

Xenon Ct ◽

Blood Flow Imaging ◽

Balloon Test Occlusion ◽

Stable Xenon

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Effect of Serotonin on Regional Cerebral Blood Flow (rCBF) in Man

Cephalalgia ◽

10.1111/j.1468-2982.1981.tb00002.x ◽

1981 ◽

Vol 1 (1) ◽

pp. 7-10 ◽

Cited By ~ 10

Author(s):

Jes Olesen

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Hemisphere ◽

Regional Cerebral Blood Flow ◽

Internal Carotid ◽

Constant Infusion ◽

Regional Cerebral Blood ◽

The Difference

With the intraarterial 133Xenon injection method, regional cerebral blood flow (rCBF) was measured from 35 regions of a cerebral hemisphere. The effect of a constant infusion of serotonin (10–33 μg/min) for 2–5 min into the internal carotid artery was studied eight times in five patients. During rest, mean rCBF was 43.5 ml/100g/min as compared to 42.6 ml/100g/min during serotonin infusion. The latter value was altered to 42.8 ml/100g/min if correction for altered PaCO2 was carried out. In neither instance was the difference significant. It is concluded that circulating serotonin is unlikely to cause the cerebrovascular alterations associated with classical migraine attacks.

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Impact of transient hypotension on regional cerebral blood flow in humans

Clinical Science ◽

10.1042/cs20140751 ◽

2015 ◽

Vol 129 (2) ◽

pp. 169-178 ◽

Cited By ~ 45

Author(s):

Nia C.S. Lewis ◽

Kurt J. Smith ◽

Anthony R. Bain ◽

Kevin W. Wildfong ◽

Tianne Numan ◽

...

Keyword(s):

Carbon Dioxide ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Vertebral Artery ◽

Regional Cerebral Blood Flow ◽

Internal Carotid ◽

Regional Cerebral Blood

Diameter reductions in the internal carotid artery (ICA) and vertebral artery (VA) contribute to the decline in brain blood with hypotension. The decline in vertebral blood flow with hypotension was greater when carbon dioxide was low; this was not apparent in the ICA.

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Clinical Utility of Quantitative Cerebral Blood Flow Measurements during Internal Carotid Artery Test Occlusions

Neurosurgery ◽

10.1227/00006123-200205000-00012 ◽

2002 ◽

Vol 50 (5) ◽

pp. 996-1005 ◽

Cited By ~ 1

Author(s):

Randolph S. Marshall ◽

Ronald M. Lazar ◽

William L. Young ◽

Robert A. Solomon ◽

Shailendra Joshi ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Clinical Utility ◽

Internal Carotid ◽

Flow Measurements ◽

Blood Flow Measurements

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Dynamic Computed Tomography Angiography in Suspected Brain Death: A Noninvasive Biomarker

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2014.02.002 ◽

2014 ◽

Vol 65 (4) ◽

pp. 352-359 ◽

Cited By ~ 1

Author(s):

Santanu Chakraborty ◽

Reem A. Adas

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Brain Death ◽

Internal Carotid ◽

External Carotid Artery ◽

External Carotid ◽

Ancillary Test ◽

Organ Harvesting

Purpose Neurologic determination of death or brain death is primarily a clinical diagnosis. This must respect all guarantees required by law and should be determined early to avoid unnecessary treatment and allow organ harvesting for transplantation. Ancillary testing is used in situations in which clinical assessment is impossible or confounded by other factors. Our purpose is to determine the utility of dynamic computed tomographic angiography (dCTA) as an ancillary test for diagnosis of brain death. Materials and Methods We retrospectively reviewed 13 consecutive patients with suspected brain death in the intensive care unit who had dCTA. Contrast appearance timings recorded from the dCTA data were compared to findings from 15 controls selected from patients who presented with symptoms of acute stroke but showed no stroke in follow-up imaging. Results The dCTA allows us to reliably assess cerebral blood flow and to record time of individual cerebral vessels opacification. It also helps us to assess the intracranial flow qualitatively against the flow in extracranial vessels as a reference. We compared the time difference between enhancement of the external and internal carotid arteries and branches. In all patients who were brain dead, internal carotid artery enhancement was delayed, which occurred after external carotid artery branches were opacified. Conclusion In patients with suspected brain death, dCTA reliably demonstrated the lack of cerebral blood flow, with extracranial circulation as an internal reference. Our initial results suggest that inversion of time of contrast appearance between internal carotid artery and external carotid artery branches at the skull base could predict a lack of distal intracranial flow.

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Cerebral Blood Flow and Metabolism Measurement Using Positron Emission Tomography before and during Internal Carotid Artery Test Occlusions: Feasibility of Rapid Quantitative Measurement of CBF and OEF/CMRO2

Interventional Neuroradiology ◽

10.1177/159101991201800304 ◽

2012 ◽

Vol 18 (3) ◽

pp. 264-274 ◽

Cited By ~ 7

Author(s):

N. Kawai ◽

M. Kawanishi ◽

A. Shindou ◽

N. Kudomi ◽

Y. Yamamoto ◽

...

Keyword(s):

Positron Emission Tomography ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

False Negative ◽

Photon Emission ◽

Emission Tomography ◽

Positron Emission

Balloon test occlusion (BTO) of the internal carotid artery (ICA) combined with cerebral blood flow (CBF) study is a sensitive test for predicting the outcome of permanent ICA occlusion. However, false negative results sometimes occur using single photon emission tomography (SPECT). We have recently developed a rapid positron emission tomography (PET) protocol that measures not only the CBF but also the cerebral oxygen metabolism before and during BTO in succession. We measured acute changes in regional CBF and OEF/CMRO2 before and during BTO in three cases with large or giant cerebral aneurysms using the rapid PET protocol. Although no patients showed ischemic symptoms during BTO, PET studies exhibited mildly to moderately decreased CBF (9∼34%) compared to the values obtained before BTO in all cases. The average OEF during BTO was significantly increased (21% and 43%) than that of before BTO in two cases. The two cases were considered to be non-tolerant for permanent ICA occlusion and treated without ICA sacrifice. Measurement of the CBF and OEF/CMRO2 using a rapid PET protocol before and during BTO is feasible and can be used for accurate assessment of tolerance prediction in ICA occlusion.

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Assessing the Effects of Antihypertensive Medication on Cerebral Blood Flow: Demonstration in Internal Carotid Artery Occlusion

DICP ◽

10.1177/106002809102501201 ◽

1991 ◽

Vol 25 (12) ◽

pp. 1299-1301 ◽

Cited By ~ 3

Author(s):

Susan C. Fagan ◽

James R. Ewing ◽

Steven R. Levine ◽

Gretchen E. Tietjen ◽

Nabih M. Ramadan ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Antihypertensive Medication ◽

Internal Carotid ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Internal Carotid Artery Occlusion ◽

Bilateral Carotid

Dynamic cerebral blood flow (CBF) studies using acetazolamide or hypercapnia as a vasodilatory challenge have attempted to evaluate intracranial hemodynamics. We report two patients with asymptomatic internal carotid artery occlusion in whom the vasodilatory stimulus was a single oral dose of antihypertensive medication (prazosin hydrochloride or enalapril maléate). In both patients, changes in regional CBF occurred that were larger than those seen in nine normal controls. One patient experienced an improvement in regional CBF with a reduction in probe pair asymmetry. In the other patient, who had bilateral carotid artery disease, a decrease in regional CBF in all 16 probes (mean decrease 12 percent) and an accentuation of the predose asymmetry were observed. Both patients remained asymptomatic throughout the study. Assessing these effects on cerebral circulation may help identify patients at risk for iatrogenic focal cerebral ischemia and provide information regarding the functional status of the cerebral vasculature.

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