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[Application and reliability of balloon occlusion test in treatment of cerebrovascular diseases]
Chao Zhang1, Ying Mao, Bing Leng
1Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
Insights
The balloon occlusion test (BOT) reliably assesses cerebral collateral circulation. Combining BOT with cross-circulation tests improves diagnostic accuracy and safety for patients undergoing neurovascular procedures.
Area of Science:
- Neurology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Cerebral collateral circulation is crucial for compensating blood flow during cerebrovascular events.
- The balloon occlusion test (BOT) is used to evaluate this compensation capacity.
- Improving BOT's reliability and safety is essential for neurovascular procedures.
Purpose of the Study:
- To assess the reliability of the balloon occlusion test (BOT) for evaluating cerebral collateral circulation.
- To investigate the validity of different BOT criteria and techniques for enhancing procedural safety.
- To determine the effectiveness of combined cross-circulation testing with BOT.
Main Methods:
- Retrospective analysis of 86 patients undergoing BOT for intracranial aneurysm or carotid cavernous fistula.
- Evaluation of conventional BOT versus combined cross-circulation and conventional BOT.
- Analysis of cerebral artery occlusion therapy outcomes and BOT-related complications.
Main Results:
- Conventional BOT showed a diagnostic positive rate of 10.47%.
- Combined cross-circulation and conventional BOT improved the diagnostic positive rate to 36.05%.
- The brain ischemia rate after artery occlusion was 8.33%, with a BOT-related complication rate of 3.49%.
Conclusions:
- Current BOT techniques provide generally reliable results for assessing collateral circulation.
- Cross-circulation and hypotensive provocative tests enhance BOT specificity.
- Further development of BOT criteria, potentially integrating advanced imaging, is needed for objective, quantifiable prediction of cerebral tolerance.
Objective:
To study the reliability of applying balloon occlusion test (BOT) to evaluate the compensation capacity of cerebral collateral circulation, and investigate the validity of different criterion about BOT and techniques to improve the security of BOT.
Methods:
A retrospective analysis was conducted on the results of 86 patients, 39 males and 47 females, aged 49.8 (13 - 72), 67 suffering from intracranial aneurysm and 19 from traumatic carotid cavernous fistula, who received BOT, and on the results of 38 of the 66 patients who accepted artery occlusion after the BOT.
Results:
The positive rate of diagnosis was 10.47% and the negative rate was 89.53% by conventional BOT; whereas the positive rate of diagnosis was 36.05% and the negative rate was 63.95% with combined cross circulation and conventional test. The brain ischemia rate after cerebral artery occlusion therapy was 8.33%. The BOT-related complication rate was 3.49%.
Conclusion:
(1) The current BOT technique can basically provide reliable results. (2) The cross circulation test and hypotensive provocative test can effectively improve the specificity of BOT. (3) More perfect BOT criterion for the prediction of cerebral tolerance is still to be worked out. Combination of the conventional method and advanced imaging technique and search for an objective and quantificational criterion would be of reward.
