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

Abstract OBJECTIVE: Internal carotid artery (ICA) balloon test occlusions (BTOs) are performed in the angiography suite to predict whether the patient has adequate collateral circulation to prevent stroke when permanent ICA occlusion (PCO) is required for treatment. Although many criteria have been proposed to facilitate predictions of stroke risk after PCO, no BTO techniques have been subjected to predictive validity testing in outcome studies. We describe a prospective case series study that tests the predictive validity of quantitative cerebral blood flow (CBF) measurements during ICA BTO. METHODS: Thirty-three patients with clinical indications for PCO underwent ICA BTO and then PCO. During BTO, standard neurological examinations, sustained-attention testing, and quantitative CBF measurements were performed. Two scalp scintillation detectors recorded washout data after ipsilateral intracarotid injection of xenon-133 through a port at the tip of the ICA-occluding balloon. Patients were monitored for the outcome measure of ipsilateral stroke for a mean of 34 months. The variables of quantitative CBF values, neurological examination results, sustained-attention test results, age, sex, and side of occlusion were examined with Kaplan-Meier log-rank tests, predictive validity analyses, and logistic regression analyses. RESULTS: CBF of less than 30 ml/100 g/min during BTO was the only variable that predicted stroke after PCO (log rank = 5.87, P = 0.015). The negative and positive predictive values for CBF findings were superior to those for standard neurological examination findings and sustained-attention test results. Age, sex, and side of occlusion did not predict stroke. CONCLUSION: Quantitative CBF testing, via the intracarotid injection technique, during BTO seems to be an important predictor of stroke after PCO.

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Microvascular bypass surgery

Journal of Neurosurgery ◽

10.3171/jns.1976.45.5.0508 ◽

1976 ◽

Vol 45 (5) ◽

pp. 508-513 ◽

Cited By ~ 51

Author(s):

Robert Spetzler ◽

Norman Chater

Keyword(s):

Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Bypass Surgery ◽

Internal Carotid ◽

Artery Blood Flow ◽

Flow Measurements ◽

Content Type ◽

Blood Flow Measurements ◽

Fine Print

✓ Intraoperative electromagnetic blood flow measurements were recorded in 15 patients undergoing extracranial-intracranial arterial bypass surgery. The initial average blood flow of 28.2 cc/min supplies 8.4% of the expected flow from one internal carotid artery. Blood flow probably increases postoperatively, as evidenced by angiographic enlargement of the bypass and its recipient cortical arteries.

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Continuous Per- and Postoperative Blood Flow Measurements on the Internal Carotid Artery after Arterial Reconstruction

Scandinavian Journal of Thoracic and Cardiovascular Surgery ◽

10.3109/14017437409130739 ◽

1974 ◽

Vol 8 (2) ◽

pp. 88-96 ◽

Cited By ~ 4

Author(s):

Hans Samnegård ◽

Stig Ekeström

Keyword(s):

Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Arterial Reconstruction ◽

Flow Measurements ◽

Blood Flow Measurements

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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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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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