Ophthalmic Artery Flow Pattern-related Stump Pressure and Ischemic Tolerance during Balloon Test Occlusion of the Internal Carotid Artery
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- IZUTSU Nobuyuki
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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- NISHIDA Takeo
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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- TAKAGAKI Masatoshi
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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- OZAKI Tomohiko
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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- TAKENAKA Tomofumi
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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- KAWABATA Shuhei
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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- MATSUI Yuichi
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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- YAMADA Shuhei
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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- TERADA Eisaku
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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- NAKAMURA Hajime
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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- KISHIMA Haruhiko
- Department of Neurosurgery, Osaka University Graduate School of Medicine
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Abstract
<p>Very few studies have described the blood flow pattern in the ipsilateral ophthalmic artery (OphA) during internal carotid artery (ICA) balloon test occlusion performed to estimate the risk of cerebral ischemia associated with therapeutic ICA sacrifice. This study aimed to investigate the relationship between ipsilateral OphA flow patterns just after ICA temporary occlusion and balloon test occlusion findings. We retrospectively reviewed 32 balloon test occlusion procedures performed at our institution between 2010 and 2019, and analyzed the OphA flow patterns and the conventional balloon test occlusion assessment items: neurological symptoms, stump pressure, stump-pressure ratio, collateral circulations, and venous phase delay. The flow patterns were categorized as type I (retrograde flow reaching the middle cerebral artery [MCA]), type II (retrograde flow to the ICA not reaching the MCA), or type III (no retrograde flow). Tolerance to balloon test occlusion was observed in 4/21 patients (19.0%), 4/6 patients (66.7%), and all five patients with types I, II, and III flows, respectively. The mean pressure ratios during balloon test occlusion in flow types I, II, and III were 35.6% ± 3.5%, 56.4% ± 6.5%, and 69.4% ± 7.1%, respectively (P <0.001). The mean stump pressures in flow types I, II, and III were 36.2 ± 3.6 mmHg, 46.6 ± 6.7 mmHg, and 66.6 ± 7.3 mmHg, respectively (P = 0.003). The mean venous phase delay in flow types I, II, and III were 0.99 ± 0.14 s, 0.25 ± 0.25 s, and 0.0 ± 0.28 s, respectively (P = 0.004). All the above variables showed significant flow-related differences. These results suggest that the OphA flow patterns may provide an additional diagnostic criterion for balloon test occlusion.</p>
Journal
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 61 (7), 433-441, 2021
The Japan Neurosurgical Society