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ation. aphy ed as ss) is inger d in-ebro-ateral ular-r ab-and d for ana-s the most rarily ly the y po-rave-s ob-on isAJNR Am J Neuroradiol 16:749–754, April 1995 Temporary balloon occlusion (TBO) of the internal carotid artery has become a well-accepted part of the preoperative evaluation of patients with aneurysm or tumor involving the neck or skull base in whom arterial sacrifice or prolonged temporary occlusion is considered a possible part of the surgical or endovascular therapy. Temporary balloon occlusion in con-junction with cerebral blood flow analysis is be-lieved to help identify the subset of patients who will not tolerate permanent carotid occlusion. In this paper we review our experience with 500 temporary carotid occlusions and evaluate the associated technique and complications. Materials and Methods All patients receive a baseline neurologic examin A baseline stable xenon–enhanced computed tomogr (Xe CT) cerebral blood flow examination is obtain well. A 6F Terumo sheath (Meditech, Watertown, Ma first placed in the femoral artery by standard Seld technique. Diagnostic angiography precedes TBO an cludes evaluation of both carotid arteries and the vert basilar system. The angiogram is assessed for coll vascular anatomy, vascular encasement, tumor vasc ity, atherosclerotic disease, and secondary vascula normalities. The angiographic catheter is withdrawn replaced with a balloon catheter, which will be use TBO. Selection of the balloon catheter is based on tomic findings from the diagnostic study as well a intended site of endovascular occlusion (1). Under circumstances, the internal carotid artery is tempo occluded in a high cervical position at approximat