Abstract
Aim: Assessment of the Cushing reflex developing during mechanical thrombectomy in a case presenting with acute ischemic stroke.Case: A 59-year-old male patient had CT angio tests due to speaking disorder and right lateral weakness developing 5 hours earlier. Acute infarctus was observed in the left MCA irrigation area with M1 segment occlusion observed in the left MCA. The decision was made to treat the patient with mechanical thrombectomy and he was transferred to the interventional neuroradiology unit. Under general anesthesia during navigation of the thromboaspiration catheter to the clot localization as the procedure was technically advancing routinely, with sudden development of bradycardia and hypertension the neuroradiology team was warned, and 1 mg IV atropine was administered for bradycardia.Simultaneously contrast material injection through the guide catheter showed the MCA M1 segment had ruptured and extravasation had developed.Conclusion: The Cushing reflex is a situation characterized by bradycardia and hypertension in cerebrovascular events causing sudden intracranial pressure increases. The most common situations observed during treatment of cerebrovascular diseases via the endovascular route is intracranial hemorrhage linked to arterial rupture. Prevention of the mortality and morbidity linked to hemorrhagic complications developing during endovascular treatment is based on early awareness and rapid treatment. Additionally, as extravasation is commonly not observed radiologically, the anesthesia team should be on the alert for the Cushing reflex and when variations of hemodynamic parameters in accordance with the Cushing response are observed, informing the operation team immediately has vital importance.
Highlights
Due to technologies developing in the last two decades, endovascular methods have gained importance for the treatment of many cerebrovascular diseases
The Cushing reflex is a situation characterized by bradycardia and hypertension in cerebrovascular events causing sudden intracranial pressure increases
The most common situations observed during treatment of cerebrovascular diseases via the endovascular route is intracranial hemorrhage linked to arterial rupture
Summary
Due to technologies developing in the last two decades, endovascular methods have gained importance for the treatment of many cerebrovascular diseases. Called the Cushing reflex after the researcher who first observed them, acknowledging these findings and informing the operation team positively changes the progress of hemorrhagic complications encountered during neuroendovascular treatments. Since the introduction of neuroendoscopy in the treatment of cerebral pathology, the problem of early recognition of any sudden increase in intracranial pressure has become crucial as introduction of via the endovascular route in the treatment of cerebral pathology [2]. In this case report, we aim to discuss a case with arterial rupture during mechanical thrombectomy for acute stroke which was not noticed during the procedure. After the Cushing reflex was identified by the anesthesia team, the arterial rupture was confirmed angiographically, necessary treatments were applied, and the case survived
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