Summary
Does the absolute value of the stump pressure (post-occlusion back pressure) become a useful index of a good collateral circulation?
The authors continuously monitored the mean arterial pressure before, during and after 20-minute balloon test occlusion in 24 patients. The stump pressure was then compared with the results of99 mTc-hexa-methyl propyleneamine (99 mTc-HMPAO) single photon emission computed tomography (SPECT) performed after 20 minutes of test occlusion.
Patients who failed to tolerate even brief periods of carotid occlusion and showed asymmetric decreases in cerebral blood flow (CBF) on SPECT were divided into high and moderate risk groups. Those with no significant change in CBF on the occluded side formed the minimum risk group.
Mean stump pressure was over 50 mmHg in three of a total of 13 patients in the high and moderate risk groups, and below 50 mmHg in two of the 11 patients in the minimum risk group. The ratios of the initial mean stump pressure to the pre-occlusion mean arterial pressure (%) and of the final mean stump pressure at the end of occlusion to the post-opening mean arterial pressure (%) did not exceed 58% in any patient in the high and moderate risk groups, and were at least 60% in all patients of the minimum risk group.
Maintenance of a mean stump pressure of 60% or more of the mean systemic pressure during test occlusion may be a more useful index of a good collateral circulation than the absolute value of mean stump pressure.
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References
Anon VV, Aymard A, Gobin YP, Casasco A, Ruffenacht D, Khayata MH, Abizanda E, Redondo A, Merland JJ (1992) Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: technical aspects, cerebral monitoring, and results. Neuroradiology 34: 245–251
Barker DW, Jungreis CA, Horton JA, Pentheny S, Lemley T (1993) Balloon test occlusion of the internal carotid artery: changes in stump pressure over 15 minutes and its correlation with Xenon CT cerebral blood flow. Am J Neuroradiol AJNR 14: 587–590
Duckwiler GD, Dion J, Vinuela F, Jabur B, Martin N, Bentson J (1990) Intravascular microcatheter pressure monitoring: experimental results and early clinical evaluation. Am J Neuroradiol AJNR 11: 169–175
Erba SM, Horton JA, Latchaw RE, Yonas H, Sekhar L, Schramm V, Pentheny S (1988) Balloon test occlusion of the internal carotid artery with stable Xenon/CT cerebral blood flow imaging. Am J Neuroradiol AJNR 9: 533–538
Heys RJ, Levinson SA, Wylie EJ (1972) Intra-operative measurement of carotid back pressure as a guide to operative management for carotid endarterectomy. Surgery 72: 953–960
Holmes AE, James IM, Wise CC (1971) Observations on distal intravascular pressure changes and cerebral blood flow after common carotid artery ligation in man. J Neurol Neurosurg Psychiatry 34: 78–81
Kelly JJ, Callow AD, O'Donnels TF, McBride K, Ehrenberg B, Korwin S, Welch H, Gembarowicz RM (1979) Failure of carotid stump pressures. Its incidence as a predictor for a temporary shunt during carotid endarterectomy. Arch Surg 114: 1361–1366
Leech PJ, Miller JD, Fitch W, Barker J (1974) Cerebral blood flow, internal carotid artery pressure, and EEG as a guide to the safety of carotid ligation. J Neurol Neurosurg Psychiatry 37: 854–862
Linsky ME, Jungreis CA, Yonas H, Hirsch WL, Sekhar LN, Horton JA, Janosky JE (1994) Stroke risk after abrupt internal carotid artery sacrifice: accuracy of pre-operative assessment with balloon test occlusion and stable xenon-enhanced CT. Am J Neuroradiol AJNR 15: 829–843
Monsein LH, Jeffery PJ, van Heeden BB, Szabo Z, Schwartz JR, Camargo EE, Chazaly J (1991) Assessing adequacy of collateral circulation during balloon test occlusion of the internal carotid artery with99 mTc-HMPAO SPECT. Am J Neuroradiol AJNR 12: 1045–1051
Moody EB, Dawson III RC, Sandler MP (1991)99 mTc- HMPAO SPECT imaging in interventional neuroradiology: validation of balloon test occlusion. Am J Neuroradiol AJNR 12: 1043–1044
Peterman SB, Taylor A, Hoffman JC (1991) Improved detection of cerebral hypoperfusion with internal carotid balloon test occlusion and99 m Tc-HMPAO SPECT imaging. Am J Neuroradiol AJNR 12: 1035–1041
Roski RA, Spetzler RF, Nulsen FE (1981) Late complications of carotid ligation in the treatment of intracranial aneurysms. J Neurosurg 54: 583–587
Spetzler RF, Schuster H, Roski RA (1980) Elective external-internal arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J Neurosurg 53: 22–27
Steed DL, Webster MW, De Vries EJ, Jungreis CA, Horton JA, Sehkar L, Yonas H (1990) Clinical observations on cerebral blood flow mapped by xenon computed tomography and its correlation with carotid artery back pressure. J Vasc Surg 11: 38–44
Sweet WH, Bennett HS (1948) Changes in internal carotid pressure during carotid and jugular occlusion and their clinical significance. J Neurosurg 4: 178–195
Tarr RW, Jungreis CA, Horton JA, Pentheny S, Sekhar LN, Sen C, Janecka IP, Yonas H (1991) Complication of preoperative balloon test occlusion of the internal carotid arteries: experience in 300 cases. Skull Base Surg 4: 240–244
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Kurata, A., Miyasaka, Y., Tanaka, C. et al. Stump pressure as a guide to the safety of permanent occlusion of the internal carotid artery. Acta neurochir 138, 549–554 (1996). https://doi.org/10.1007/BF01411175
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DOI: https://doi.org/10.1007/BF01411175