Application and reliability of the superselective balloon occlusion test in the treatment of complex cerebral artery aneurysms: A report of 12 cases.

Although the general balloon occlusion test (BOT) is commonly used, there is limited information on the evaluation standards and methodological protocols for the superselective BOT, which may be required in some special aneurysm cases. We performed the superselective BOT in 12 patients with specific complex aneurysms and report our experiences herein. We retrospectively analyzed the angiographic results and test outcomes of 12 patients (8 men and 4 women) who underwent the superselective BOT to evaluate their collateral flow before treatment. Eight patients had middle cerebral artery complex aneurysms; 2 patients had carotid-ophthalmic aneurysms; and 2 patients had posterior cerebral artery aneurysms. Collaterals were categorized as none (grade 0), poor (grades 1 or 2), or good (grades 3 or 4) based on the collateral flow grade on angiography. The test results were negative in 10 patients and positive in 2 patients. The delay time of the cortical capillary phase after temporary occlusion of the parent artery was between 0.5 and 2.5 s. The collateral flow was graded as poor in 3 patients and good in 9 patients. There were no technical complications related to the superselective BOT. The superselective BOT can be applied for the evaluation of some complex aneurysms prior to treatment. The right method of occlusion can be selected on the basis of the results of this test.