Complication of temporary balloon test occlusion of the internal carotid artery: Experience in 119 cases

Currently, temporary balloon test occlusion (BTO) of the internal carotid artery (ICA) has become a well accepted procedure in the preoperative evaluation of patients with large aneurysm or tumor involving the neck or skull base in whom arterial sacrifice or prolonged temporary occlusion is considered. In this paper we review our experience with 119 cases of BTO and evaluate the associated techniques and complications. BTO of the ICA was accomplished endovascularly using triple-lumen balloon catheter. After ICA occlusion using the balloon, the patient's neurological status was assessed and monitored continuously throughout 30 minutes. When the patient showed neurological changes, BTO was immediately stopped. Complication related to this procedure occurred in 5 (4.2%) patients. Two (1.7%) patients had symptomatic and three (2.5%) had asymptomatic complications. One (0.8%) of these was a permanent neurological deficit due to ICA dissection caused by the balloon catheter. The other (0.8 %)was embolic M2 occlusion resulted in transient neurological deficit. There were no death related this procedure. BTO of the ICA can be performed with an acceptable low complication rate, however, it should be performed by the experienced hand and under strict indication.