Temporary balloon occlusion of the carotid artery combined with SPECT as a test to predict tolerance prior to permanent carotid sacrifice

Objective To report our experience in the combination temporary internal carotid balloon occlusion with SPECT cerebral blood flow imaging in preoperative evaluation of those patients with neoplastic lesions in the head and neck whose internal carotid artery may be sacrificed during operation. Methods 21patients were evaluated for permanent carotid occlusion. Each patient underwent trial occlusion of either an internal carotid artery or common carotid artery. With the patient sedated but awake, a balloon catheter was angiographically introduced from the femoral artery , brought into position in the carotid artery above bifurcation and inflated for 45 min. Patients were evaluated continuously for development of neurologic deficits. Each patient was injected intravenously with approximately 25 ml 99mTe ECD near the end of the 30 min occlusion period, then brought to the nuclear medicine department for SPECT scanning. Results Of the 27 patients with neoplastic lesions in the head and neck, 17 negative cases and 10 positive cases. The positive signs include neurologic symptoms during temporary occlusion and a perfusion defect on SPECT. Quantitative analysis may find more subtle changes. According to these findings, 8 patients had bypass at the same time of resection and reconstructed carotid artery with biograft later and 7 patient underwent carotid sacrifice without carotid reconstruction. No patient developed neurologic symptom postoperatively. Conclusion The trial balloon occlusion with SPECT scanning is also useful in evaluating whether a patient can tolerate carotid sacrifice without developing neurologic deficits, and these data are of value not only for diagnostic purpose but also to plan an alternative treatment strategy.