2017 年 11 巻 7 号 p. 351-358
Objective: When internal carotid artery occlusion is performed for the treatment of an aneurysm, it is important to judge whether or not bypass surgery should be performed for the prevention of complications by the balloon occlusion test (BOT), but there are no clear criteria for the judgment. In this study, we evaluated the long-term results in patients who underwent internal carotid artery occlusion without bypass surgery.
Methods: In all, 33 patients with 34 aneurysms who showed no symptoms, a venous phase delay of within 2 seconds, and a mean stump pressure of ≥40 mmHg on a 20-minute BOT between April 2001 and March 2015 and were treated by endovascular internal carotid artery occlusion under local anesthesia without bypass surgery were evaluated.
Results: There were no periprocedural deaths, periprocedural ischemic complications were observed in four patients (12%), and they persisted in two patients (6%). On postprocedural diffusion-weighted magnetic resonance (MR) imaging, high intensity signal areas were observed in 25 patients (75%). In all, 30 patients could be followed up on an outpatient basis, and symptomatic cerebral infarction, which was cardiogenic, was noted in one patient (3.3%) during a mean follow-up period of 65.3 months. The final evaluation using DSA or MRA, which was performed after a mean of 63.7 months, revealed aneurysm recurrence in one patient and de novo aneurysm formation in one patient.
Conclusion: With judgment of whether or not bypass surgery should be performed according to the results of the BOT, endovascular internal carotid artery occlusion is a safe treatment with a favorable long-term outcome.