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P19 Background: Temporary balloon occlusion (TBO)  helps assess the safety of ICA sacrifice in the treatment of aneurysms  and head/neck cancers. Several techniques have been used in combination  with the clinical exam during TBO to predict low flow ischemia after  permanent occlusion (SPECT, MR, Xenon-CT, EEG, TCD). All have poor  predictive value. Continuous jugular bulb oximetry (SjvO2 )  provides easily interpretable, real-time data about cerebral oxygen  extraction. It is a surrogate measure for CBF under steady-state  conditions and can identify hemispheric hypoperfusion.Methods: An oximetric catheter was placed in the jugular  bulb that preferentially drained the hemisphere in question. In the  setting of systemic heparinization and continuous neurologic  monitoring, TBO of the ICA was performed for 30 min. Hypotension to  70% of baseline BP was induced with nitroprusside for the last 15 min  of the TBO. SjvO2 and MAP were sampled at 0.5 Hz. A slope  changepoint for the MAP vs. SjvO2 relationship was  calculated with a two-phase linear regression model, to identify the  point at which SjvO2 became independent of MAP. This inflection point  defines the autoregulatory portion of the MAP vs. SjvO2 curve. SPECT tracer (5 patients) was injected during hypotension when  available. TBO failure was based on SPECT and symptoms, blinded to the  SjvO2 data.Results: 10 consecutive patients  (mean age 57, 30% male, 40% with hypertension) were studied, 3 of  whom failed TBO. Two showed ischemic symptoms referable to the ICA  tested (1 with normal SPECT), and 1 had equivocal symptoms but  hemispheric hypoperfusion on SPECT. All 3 developed  SjvO2 ≤ 45% at a MAP &gt; 70 mmHg. In the 3  patients who failed TBO, the changepoint on the MAP vs.  SjvO2 curves occurred at a higher MAP value than in the  patients who passed TBO (mean MAP 100 vs. 72; p=. 05). The 7 patients  without symptoms or abnormal SPECT tolerated sacrifice.Conclusion: Continuous SjvO2 monitoring may help  identify patients who are still at risk for delayed ischemia despite  subtle or no neurologic symptoms during TBO. It may also help guide  post-occlusion hemodynamic management in patients with changepoints  above 70 mmHg. Further study is warranted.

Continuous Monitoring of Jugular Bulb Oxygenation during Carotid Temporary Balloon Occlusion