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Ischemic Tolerance Evaluated by Computed Tomography Perfusion during Balloon Test Occlusion.

Tomoyoshi Kuribara1, Takeshi Mikami1, Satoshi Iihoshi2

  • 1Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|April 17, 2020
PubMed
Summary

Computed tomography (CT) perfusion during balloon test occlusion (BTO) can assess ischemic tolerance. Mean transit time (MTT) via CT perfusion effectively predicts tolerance for permanent parent artery occlusion, aiding in detecting delayed ischemic stroke.

Keywords:
Balloon test occlusioncerebral blood flowcomputed tomography perfusionmean transit timestump pressure

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Area of Science:

  • Neurology
  • Radiology
  • Vascular Surgery

Background:

  • Balloon test occlusion (BTO) assesses ischemic tolerance for parent artery occlusion in cerebral aneurysms and tumors.
  • Temporary occlusion tolerance does not always predict permanent occlusion tolerance.
  • Delayed ischemic stroke remains a risk after permanent occlusion.

Purpose of the Study:

  • Evaluate computed tomography (CT) perfusion during BTO to quantify ischemic tolerance.
  • Determine the utility of CT perfusion parameters in predicting delayed ischemic stroke.
  • Correlate CT perfusion findings with collateral angiographic appearance and stump pressure.

Main Methods:

  • Forty-one patients undergoing internal carotid artery BTO were included.
  • CT perfusion parameters (CBF, CBV, MTT, TTP) and asymmetry ratios were analyzed.
  • Collateral angiographic appearance was graded (0-4), and stump pressure was measured.

Main Results:

  • Mean transit time (MTT) showed the strongest correlation with collateral angiographic appearance and stump pressure.
  • Significant differences in CBF and MTT were observed between poor and good collateral groups.
  • MTT achieved 75.0% sensitivity and 81.2% specificity in identifying good collateral status.

Conclusions:

  • CT perfusion, particularly MTT, is a valuable tool for quantifying ischemic tolerance during BTO.
  • MTT can help identify patients at risk for delayed ischemic stroke after parent artery occlusion.
  • This technique enhances the assessment of cerebrovascular reserve before permanent occlusion.