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Advances in skull base surgery have resulted in the ability to perform large scale en bloc resections of neoplasms of the clivus, sphenoid wings, sella, and other deep structures. Such tumors frequently involve the internal carotid artery (ICA), and complete resection may require dissection or sacrifice of the ICA. ICA occlusion without graft placement is performed to treat certain aneurysms— for example, fusiform cavernous ICA aneurysms with mass effect or partially thrombosed pseudoaneurysms with embolic potential. These and other less common indications for ICA sacrifice necessitate our ability to predict the results of ICA occlusion. There is some variability in the performance and reporting of balloon test occlusion (BTO). This paper represents a consensus statement of the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery, with the goal of providing standardized recommendations for indication, performance, documentation, and complication reporting of BTO procedures.
Without any type of temporary test occlusion, the incidence of stroke after permanent carotid artery occlusion ranges from 17% to 30%.1–5 In 1911, Matas6 described temporary arterial occlusion by manual compression of the common carotid artery to determine tolerance for permanent arterial occlusion. Serbinenko7 introduced the concept of endovascular arterial occlusion using small endovascular balloons in the early 1970s. His novel method of endovascular arterial occlusion has since been widely adopted and remains the current foundation for temporary arterial test occlusion.
When carotid artery BTO is clinically tolerated, the morbidity and mortality associated with permanent arterial occlusion are reduced but, unfortunately, not eliminated. Since the report of endovascular temporary arterial occlusion presented by Serbinenko7 was published, a variety of adjunctive methods have been tested to improve the sensitivity and specificity of clinical neurologic evaluation alone for the detection of insufficient cerebral …
Contributors All authors contributed to: the interpretation of relevant data (publications), critical revision of the document for important intellectual content, or approval of the final version.
Competing interests None.
Provenance and peer review Commissioned; not externally peer reviewed.