Balloon Test Occlusion

Abstract Balloon test occlusion (BTO) is an endovascular procedure in which a balloon is temporarily inflated in an artery in order to evaluate the potential for collateral circulation to compensate for its absence. In cases of complex aneurysms or neoplasia, artery sacrifice may be necessary to treat the pathology, and this test occlusion is used to determine the need for revascularization. For lesions affecting the carotid artery, a surprising majority of patients can tolerate occlusion permanently, but devastating ischemia can occur in others. The BTO, along with adjunctive nuclear medicine blood flow measurements, serve to increase the preprocedure probability that permanent occlusion will be tolerated without ischemic complication. Herein, we review the indications, techniques, nuances, and potential complications associated with the BTO.