Cushing Reflex and Importance during Treatment of Cerebrovascular Diseases via Endovascular Route

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.