Issue release date: 12.11.2024
2Chutoen General Medical Center, Department of Neurosurgery, Kakegawa, Japan DOI : 10.5137/1019-5149.JTN.32736-20.2 AIM: To develop a protocol of balloon test occlusion (BTO) to perform single-photon emission computed tomography (SPECT) only in cases that require it by using mean stump pressure (MSTP).
MATERIAL and METHODS: BTO was performed in 52 consecutive patients (derivation group). Using the derivation group data, a protocol was created and applied to 55 consecutive patients (validation group).
RESULTS: In the derivation group, all patients with MSTP ?65 mmHg had an ischemic tolerance, whereas those with MSTP ?45 mmHg were considered ischemic intolerant. Based on these results, we developed a protocol wherein MSTP between 45 mmHg and 65 mmHg was defined as ?ischemic borderzone? and SPECT was performed in these cases. Using this protocol, BTO was performed in the validation group and 19 patients were treated with parent artery occlusion with or without bypass. In two cases that did not follow the protocol, the occurrence of hypoperfusion caused cerebral infarction after treatment. However, if this protocol had been followed for all cases, no false-negative cases of BTO would have occurred.
CONCLUSION: By measuring MSTP and identifying the approximate ischemic tolerability, the current protocol can identify cases requiring SPECT, which is particularly reliable but complicated. Moreover, this protocol would be especially useful for reducing false-negative cases of BTO.
Keywords : Balloon test occlusion, Carotid artery sacrifice, Ischemic tolerance, Mean stump pressure, Cerebral blood flow