Cushing reflex: A sign of vessel perforation during mechanical thrombectomy performed under general anesthesia

Abstract

We aimed to present the assessment of the Cushing reflex caused by intracranial haemorrhagia developing during mechanical thrombectomy in a case presenting with acute ischemic stroke. A 59-year old male patient was scanned by CT angio due to speaking disorder and right lateral weakness developing 5 hours earlier. Acute infarction 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 anesthesiology team was warned and 1 mg IV atropine was administered for bradycardia. Acute infarction has to be removed because it is understood as mechanical thrombectomy has been performed to a patient with an infarction. Simultaneously contrast material injection through the guide catheter showed the MCA M1 segment had ruptured and extravasation had developed. As conclusion, anesthesia and operation team must be alert for vessel perforation when Cushing triad develops during navigation of the thromboaspiration catheter.

Successful Reperfusion is Associated with Favorable Functional Outcome despite Vessel Perforation during Thrombectomy: A Case Series and Systematic Review

“…Vessel perforation is arguably one of the most serious and feared complications during EVT and is associated with high rates of mortality. [3][4][5]9,10 The risk of vessel perforation is increased during ''blind maneuvering'' while trying to gain access to occluded intracranial vessels with a microwire or microcatheter [11][12][13][14][15][16][17] and while withdrawing a stent retriever. 5,18,19 Vessel perforation tends to involve more distal vessel segments: 65% of cases in our study and 61% in our literature review.…”