Retrospective Study
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World J Radiol. Aug 28, 2014; 6(8): 619-624
Published online Aug 28, 2014. doi: 10.4329/wjr.v6.i8.619
Balloon test occlusion of internal carotid artery: Angiographic findings predictive of results
Kazufumi Kikuchi, Takashi Yoshiura, Akio Hiwatashi, Osamu Togao, Koji Yamashita, Hiroshi Honda
Kazufumi Kikuchi, Takashi Yoshiura, Akio Hiwatashi, Osamu Togao, Koji Yamashita, Hiroshi Honda, Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Author contributions: All the authors were involved in designing the study and editing; Kikuchi K made substantial contributions to data analysis and interpretation, performed the statistical analysis, wrote the manuscript draft, and revised it critically according the suggestions of the other authors; Hiwatashi A, Togao O, Yamashita K and Honda H made substantial contributions to data analysis, interpretation, finding the pictures, and helped draft the manuscript; Yoshiura T made substantial contributions to the study conception and design, critically revised the manuscript draft for important intellectual content, and gave final approval of the version to be published; all the authors read and approved the final manuscript.
Supported by JSPS KAKENHI, No. 26461828
Correspondence to: Takashi Yoshiura, MD, PhD, Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. tyoshiu@radiol.med.kyushu-u.ac.jp
Telephone: +81-92-6425695 Fax: +81-92-6425708
Received: April 28, 2014
Revised: June 24, 2014
Accepted: July 17, 2014
Published online: August 28, 2014
Processing time: 122 Days and 0.5 Hours
Abstract

AIM: To reveal angiographic findings to predict the result of balloon test occlusion (BTO).

METHODS: The cerebral angiograms of 42 consecutive patients who underwent cerebral angiography including both the Matas and Allcock maneuvers and BTO were retrospectively analyzed. Visualization of the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) by the cross flow on the tested side during the Matas or Allcock maneuver was graded on a 5-point scale. Circle of Willis (COW) anatomy with respect to the presence/absence of a collateral path to reach the tested internal carotid artery (ICA) was classified into four categories. A univariate logistic analysis was used to analyze the associations between each angiographic finding and the BTO result. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for each finding were calculated.

RESULTS: Five patients (12%) were BTO-positive and the remaining 37 patients (88%) were BTO-negative. Visualizations of the ACA and MCA as well as the COW anatomy were significantly associated with the BTO result (P = 0.0051 for ACA, P = 0.0002 for MCA, and P < 0.0001 for COW anatomy). In particular, good MCA visualization and the presence of an anterior connection (collateral path to the tested ICA from the contralateral ICA via the anterior communicating artery) in the COW were highly predictive for negative BTO (negative predictive value = 100% for both).

CONCLUSION: A BTO result may be predicted by angiographic findings including ACA/MCA visualization and COW anatomy.

Keywords: Balloon test occlusion; Cross flow; Circle of Willis; Anterior circulation; Posterior circulation

Core tip: Balloon test occlusion (BTO) is widely performed to assess the ischemic tolerance among preoperative patients. It is safe and useful, however, it sometimes carries the risk of thrombosis, dissection and infarction. Our study revealed that visualizations of the anterior cerebral artery and middle cerebral artery (MCA) as well as the circle of Willis (COW) anatomy were significantly associated with the BTO result. In particular, good MCA visualization and/or the presence of an anterior connection [collateral path to the tested internal carotid artery (ICA) from the contralateral ICA via the anterior communicating artery] in the COW were highly predictive for negative BTO.