Brain perfusion imaging during preoperative temporary balloon occlusion of the internal carotid artery

Mordechai Lorberboym*, Neeta Pandit, Josef Machac, Victor Holan, Michael Sacher, David Segal, Chandranath Sen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The main objective of this study was to assess whether 99mTc-HMPAO brain SPECT imaging can identity patients at high risk of developing an infarct following permanent carotid occlusion in the course of brain surgery. Methods: Test balloon occlusion of the internal carotid artery was performed in 44 patients with a variety of heed and neck tumors or aneurysms. Technetium-99m-HMPAO was injected intravenously while the balloon was inflated and a SPECT study was obtained 30 min later. Follow-up CT scans were obtained routinely for all patients at 2 wk and 1 mo following surgery, or earlier when necessary. Thirty patients and five normal volunteers had semiquantitative analysis of cerebral perfusion. Results: Twenty-six patients demonstrated ipsilateral perfusion abnormalities during trial occlusion. Eight patients in this group underwent bypass grafting prior to sacrifice of the artery: two resulting in infarcts. Eighteen patients had symmetric cerebral perfusion during occlusion and four of these patients underwent permanent therapeutic carotid occlusion; three patients had subsequent infarcts and the fourth patient had an impending stroke. Conclusion: Patients with symmetric cerebral perfusion measured by 99mTc-HMPAO SPECT may still have a high long-term complication rate following carotid sacrifice. The scan findings in these patients were not predictive of the outcome. Patients with asymmetric cerebral perfusion had alternative therapeutic approach to carotid sacrifice and most of them had good surgical outcomes.

Original languageEnglish
Pages (from-to)415-419
Number of pages5
JournalJournal of Nuclear Medicine
Issue number3
StatePublished - Mar 1996
Externally publishedYes


  • carotid artery
  • cerebral perfusion
  • technetium-99m-HMPAO
  • test occlusion


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