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Acta Neurochirurgica

, Volume 139, Issue 11, pp 1066–1073 | Cite as

Cerebral haemodynamics in internal carotid artery trial occlusion

  • A. Sorteberg
  • W. Sorteberg
  • S. J. Bakke
  • K. -F. Lindegaard
  • M. Boysen
  • H. Nornes
Clinical Research

Summary

The purpose of this study was to analyse the cerebral haemodynamic changes brought about by trial occlusion of the internal carotid artery (ICA). Sixteen patients with surgically inaccessible cerebral aneurysms, carotid cavernous fistulas or neck neoplasms were monitored with transcranial Doppler ultrasonography (TCD) during 90–120 s angiographie ICA balloon occlusion or ICA closure with a Selverstone clamp. The blood velocity (V) was registered continuously in both middle cerebral arteries (MCA) while the pulsatility index (PIMCA) and haemodynamic tension (Uhemmca) were calculated.

ICA closure led to an instantaneous drop in the ipsilateral V mca , PI mca and Uhemmca. The V mca thereafter increased gradually until reaching a stable level. The subjects were grouped into those with initial drops in V mca to ≥ 60% of pre-occlusion value (group 1) and those that fell to < 60% (group 2), respectively. In group 1 autoregulatory mechanisms made the PI mca decline further, while the Uhemmca remained unaltered during ICA closure. In group 2, however, the PI mca did not change further, while the Uhemmca increased slightly. The cerebral haemodynamic features during ICA test occlusion were thus essentially different in the two groups. On re-opening the ICA, there was an overshoot in V mca and Uhemmca. Contralaterally, the V mca was increased during ICA occlusion.

Seven of the patients later had their ICA closed permanently. While none of five group 1 patients developed haemodynamic complications, two group 2 individuals experienced haemodynamic stroke. Assuming ICA sacrifice is feasable when test occlusion results in an ipsilateral initial reduction in V mca to ≥ 60% of preocclusion value, the corresponding limit for the Uhemmca is ≥ 40%. In the pre-operative evaluation of the haemodynamic risk related to ICA loss, TCD emerges as a reliable method. It also seems to allow for the reduction of test occlusion time to 90–120 s.

Keywords

Transcranial Doppler ultrasonography balloon occlusion test internal carotid artery cerebral haemodynamics 

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Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • A. Sorteberg
    • 1
  • W. Sorteberg
    • 1
  • S. J. Bakke
    • 2
  • K. -F. Lindegaard
    • 1
  • M. Boysen
    • 3
  • H. Nornes
    • 1
  1. 1.Department of Neurosurgery, The National HospitalUniversity of OsloOsloNorway
  2. 2.Department of Radiology, Neuroradiological Section, The National HospitalUniversity of OsloOsloNorway
  3. 3.Department of Otolaryngology, Rikshospitalet, The National HospitalUniversity of OsloOsloNorway

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