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Venous Phase Timing Does Not Predict SPECT Results During Balloon Test Occlusion of the Internal Carotid Artery
Brian M Snelling1, Samir Sur1, Sumedh S Shah1
1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Insights
Venous phase timing did not correlate with SPECT findings in predicting hypoperfusion after internal carotid artery (ICA) occlusion. Further research is needed to identify reliable methods for assessing risks before carotid sacrifice.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Internal carotid artery (ICA) sacrifice is a treatment option for certain cerebrovascular conditions.
- Predicting potential complications like hypoperfusion is crucial before vessel sacrifice.
- Technetium-99m Single Photon Emission Computed Tomography (SPECT) is used to assess cerebral blood flow.
Purpose of the Study:
- To evaluate the correlation between venous phase timing and SPECT findings.
- To determine the predictive value of venous phase timing for hypoperfusion during balloon test occlusion of the ICA.
- To assess the safety of subsequent ICA sacrifice based on these tests.
Main Methods:
- Fifty-six patients undergoing balloon test occlusion of the ICA were studied.
- Venous phase timing was calculated, and SPECT imaging was performed.
- Patients were grouped based on SPECT findings: No Hypoperfusion, Mild Hypoperfusion, and Moderate/Severe Hypoperfusion.
Main Results:
- No significant difference in venous phase timing was found across the three hypoperfusion groups (P = 0.22).
- Patients with no hypoperfusion had an average venous delay of 0.65 seconds.
- Patients with moderate/severe hypoperfusion had a longer average venous delay of 1.08 seconds.
Conclusions:
- Venous phase timing does not correlate with SPECT findings in predicting hypoperfusion after ICA balloon occlusion.
- Current methods may not be sufficient to predict delayed ischemia following carotid occlusion.
- Additional studies are required to identify optimal adjunctive measures for risk assessment before ICA sacrifice.
Introduction:
The purpose of this study is to evaluate the role of venous phase timing when compared with technetium-99m Single Photon Emission Computed Tomography (SPECT) during angiographic balloon test occlusion of the internal carotid artery (ICA) and subsequent sacrifice of the ICA.
Methods:
Fifty-six patients underwent formal balloon test occlusion from April 2008 to February 2014 at our institution. Venous phase timing was calculated for each patient. SPECT imaging for each patient was interpreted by the nuclear medicine radiologist. Statistical analysis on the 3 groups (No Hypoperfusion, Mild Hypoperfusion, Moderate/Severe Hypoperfusion) was calculated using analysis of variance.
Results:
Twenty-six patients showed no hypoperfusion during SPECT. The average delay of venous phase for these patients was 0.65 seconds. Eight of the 26 patients went on to have vessel sacrifice, with none showing evidence of infarction at the time of discharge. Six patients showed evidence of mild hypoperfusion on SPECT. None of these patients went on to have vessel sacrifice. The average venous delay was 0.5 seconds. Twenty-four patients were found to have moderate or severe hypoperfusion. The average venous delay was 1.08 seconds. Analysis of variance among the 3 groups demonstrated no significant difference (P = 0.22).
Conclusion:
Our study demonstrated no correlation between venous phase timing and SPECT. Future studies comparing multiple tests with patients who have had vessel occlusion are necessary to determine the best adjunctive measures to predict delayed ischemia following carotid occlusion.
