Balloon Occlusion of Internal Carotid for the Treatment of Giant Inoperable Aneurysms

Fifteen patients with inoperable giant aneurysms of the internal carotid system were treated by proximal balloon occlusion of the internal carotid. Each patient was assessed with I.V. xenon 133 cerebral blood flow (rCBF) before and during test balloon occlusion. One patient had a low CBF less than 40 ml/100 gm/min and received an EC-IC bypass before balloon occlusion. He developed a transient weakness of upper extremity following balloon occlusion. The weakness recovered completely within one hour and was considered probably related to embolism. Three patients had low CBF and had their CBF augmented with manitol (to 40 ml/100 gm/min), followed by balloon occlusion of internal carotid. Every patient was clinically assessed for tolerance during balloon test occlusion of the internal carotid before the balloon was detached. One patient had a mild stroke during catheterization and the procedure was terminated. One posterior communication artery aneurysm and one supraclinoid aneurysm with a persistent trigeminal artery did not thrombose completely. Otherwise the patients are doing well on a six month to four year follow up.