Balloon Test Occlusion with Perfusion CT Imaging Utilizing Intraarterial Contrast Injection

Area of Science:

• Vascular Surgery
• Neuroradiology
• Medical Imaging

Background:

• Balloon Test Occlusion (BTO) assesses collateral circulation for planned carotid artery occlusion.
• Standard BTO with neurological evaluation has a high false-negative rate.
• Adjunctive techniques are needed to improve BTO sensitivity.

Purpose of the Study:

• To evaluate the efficacy and safety of combining BTO with Perfusion CT (PCT).
• To assess the utility of intraarterial contrast injection during BTO-PCT procedures.

Main Methods:

• Seven patients underwent combined BTO and PCT in an angio/CT suite.
• PCT utilized intraarterial contrast injection for perfusion map generation (CBF, CBV, TTP).
• SPECT imaging was performed in three patients for comparison.

Main Results:

• All procedures were performed safely without morbidity.
• PCT revealed significant decreases in cerebral blood flow (CBF) in three patients, despite clinical BTO success.
• Intraarterial injection yielded excellent time-attenuation curves with reduced contrast and radiation.

Conclusions:

• BTO combined with PCT is a safe and effective method for evaluating collateral flow.
• This combined approach enhances the sensitivity of BTO, identifying potential hypoperfusion missed by clinical assessment alone.
• Intraarterial contrast delivery in PCT during BTO optimizes imaging quality and patient safety.