Comparison of practical methods in clinical sites for estimating cerebral blood flow during balloon test occlusion

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OBJECTIVE

The authors sought to compare methods of measurement for venous phase delay (VPD) or mean stump pressure (MSTP) to rank their potential to predict ischemic tolerance during balloon test occlusion in the internal carotid artery, exploring a more correlative and convenient way to measure cerebral blood flow (CBF) that could be utilized even in the acute phase or in institutions not adequately equipped to measure CBF during the test.

METHODS

X-ray angiography perfusion analysis using diagnostic digital subtraction angiography (DSA) equipment enables 1-step examination (without any room-to-room transfer of patients) to measure CBF, VPD, and MSTP completely simultaneously, which has not been accomplished by any previous perfusion studies.

RESULTS

This analysis was applied to 17 patients and resulted in successful estimation of all 3 parameters in each case. The average VPD of several cortical veins had a strong correlation with relative CBF (rCBF) between bilateral hemispheres with a correlation coefficient of 0.89443, a correlation as strong as that (0.90357) of the “approximate VPD,” which is interpreted based on the trend line of the scatterplot of the time to peak contrast opacification in cortical veins and their spatial positioning from the median sagittal plane. MSTP and classic visual determination of VPD have weaker correlation coefficients with rCBF (0.56119 and 0.70048, respectively). Overall, subjective visual determination in combination with the calculation of the trend line to estimate VPD provided a considerably strong correlation with rCBF (R = 0.86660) without any dedicated software or hardware.

CONCLUSIONS

VPD has a stronger correlation with rCBF than MSTP. rCBF could be successfully predicted on common DSA equipment, even by visual determination without expensive software, if the trend line is adopted for processing to estimate VPD.

ABBREVIATIONS ACA = anterior cerebral artery; ACoA = anterior communicating artery; AUC = area under the curve; BTO = balloon test occlusion; CBF = cerebral blood flow; CBV = cerebral blood volume; cvTTP = cortical vein TTP; DSA = digital subtraction angiography; ICA = internal carotid artery; MCA = middle cerebral artery; MSTP = mean stump pressure; MTT = mean transit time; PA = posteroanterior; PCoA = posterior communicating artery; rAUC = relative AUC; rCBF = relative CBF; rMSTP = relative MSTP; rMTT = relative MTT; ROI = region of interest; TTP = time to peak; VPD = venous phase delay; XAP = x-ray angiography perfusion.
Article Information

Contributor Notes

Correspondence Shoichi Tani: Kobe City Medical Center General Hospital, Kobe, Japan. stanistanistani@herb.ocn.ne.jp.INCLUDE WHEN CITING Published online November 16, 2018; DOI: 10.3171/2018.5.JNS18858.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Abud DGSpelle LPiotin MMounayer CVanzin JRMoret J: Venous phase timing during balloon test occlusion as a criterion for permanent internal carotid artery sacrifice. AJNR Am J Neuroradiol 26:260226092005

    • Search Google Scholar
    • Export Citation
  • 2

    Asai KImamura HMineharu YTani SAdachi HNarumi O: X-ray angiography perfusion analysis for the balloon occlusion test of the internal carotid artery. J Stroke Cerebrovasc Dis 24:150615122015

    • Search Google Scholar
    • Export Citation
  • 3

    Asai KNakamura HWatabe TNishida TSakaguchi MHatazawa J: X-ray angiography perfusion imaging with an intra-arterial injection: comparative study with 15O-gas/water positron emission tomography. J Neurointerv Surg 10:7807832018

    • Search Google Scholar
    • Export Citation
  • 4

    Bechan RSMajoie CBSprengers MEPeluso JPSluzewski Mvan Rooij WJ: Therapeutic internal carotid artery occlusion for large and giant aneurysms: a single center cohort of 146 patients. AJNR Am J Neuroradiol 37:1251292016

    • Search Google Scholar
    • Export Citation
  • 5

    Erba SMHorton JALatchaw REYonas HSekhar LSchramm V: Balloon test occlusion of the internal carotid artery with stable xenon/CT cerebral blood flow imaging. AJNR Am J Neuroradiol 9:5335381988

    • Search Google Scholar
    • Export Citation
  • 6

    Gevers SHeijtel DFerns SPvan Ooij Pvan Rooij WJvan Osch MJ: Cerebral perfusion long term after therapeutic occlusion of the internal carotid artery in patients who tolerated angiographic balloon test occlusion. AJNR Am J Neuroradiol 33:3293352012

    • Search Google Scholar
    • Export Citation
  • 7

    Kurata AMiyasaka YTanaka COhmomo TYada KKan S: Stump pressure as a guide to the safety of permanent occlusion of the internal carotid artery. Acta Neurochir (Wien) 138:5495541996

    • Search Google Scholar
    • Export Citation
  • 8

    Sato KShimizu HInoue TFujimura MMatsumoto YKondo R: Angiographic circulation time and cerebral blood flow during balloon test occlusion of the internal carotid artery. J Cereb Blood Flow Metab 34:1361432014

    • Search Google Scholar
    • Export Citation
  • 9

    Shimizu KImamura HMineharu YAdachi HSakai CTani S: Endovascular parent-artery occlusion of large or giant unruptured internal carotid artery aneurysms. A long-term single-center experience. J Clin Neurosci 37:73782017

    • Search Google Scholar
    • Export Citation
  • 10

    Steed DLWebster MWDeVries EJJungreis CAHorton JASehkar L: Clinical observations on the effect of carotid artery occlusion on cerebral blood flow mapped by xenon computed tomography and its correlation with carotid artery back pressure. J Vasc Surg 11:38441990

    • Search Google Scholar
    • Export Citation
  • 11

    Tomura NOmachi KTakahashi SSakuma IOtani TWatarai J: Comparison of technetium Tc 99m hexamethylpropyleneamine oxime single-photon emission tomograph with stump pressure during the balloon occlusion test of the internal carotid artery. AJNR Am J Neuroradiol 26:193719422005

    • Search Google Scholar
    • Export Citation
  • 12

    Torigai TMase MOhno TKatano HNisikawa YSakurai K: Usefulness of dual and fully automated measurements of cerebral blood flow during balloon occlusion test of the internal carotid artery. J Stroke Cerebrovasc Dis 22:1972042013

    • Search Google Scholar
    • Export Citation
  • 13

    van Rooij WJSluzewski MSlob MJRinkel GJ: Predictive value of angiographic testing for tolerance to therapeutic occlusion of the carotid artery. AJNR Am J Neuroradiol 26:1751782005

    • Search Google Scholar
    • Export Citation
  • 14

    Wojak JCAbruzzo TABello JABlackham KAHirsch JAJayaraman MV: Quality improvement guidelines for adult diagnostic cervicocerebral angiography: update. Cooperative study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 26:159616082015

    • Search Google Scholar
    • Export Citation
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