Türk Beyin Damar Hast Derg. 2018; 24(2): 82-86 | DOI: 10.5505/tbdhd.2018.50251

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

Bedih Balkan¹, Abdülcelil Gezmiþ¹, Ahmet Tolga Erol¹, Batuhan Kara², Hatem Hakan Selçuk², Abdulkadir Yektaþ^3
1TC. Medical Sciences University Bakýrköy Dr. Sadi Konuk Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey
²TC. Medical Sciences University Bakýrköy Dr. Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
³TC. Medical Sciences University Diyarbakýr Gazi Yaþargil Training and Research Hospital, Department of Anesthesiology and Reanimation, Diyarbakýr, Turkey

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.

Keywords: Cushing reflex, acute stroke, mechanical thrombectomy, general anesthesia, vessel perforation.

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Cushing refleksi: Genel anestezi altýnda yapýlan mekanik trombektomi esnasýnda damar perforasyonun bir iþareti

Bedih Balkan¹, Abdülcelil Gezmiþ¹, Ahmet Tolga Erol¹, Batuhan Kara², Hatem Hakan Selçuk², Abdulkadir Yektaþ^3
1TC. Saðlýk Bilimleri Üniversitesi Bakýrköy Dr. Sadi Konuk Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reanimasyaon Kliniði, Ýstanbul
²TC. Saðlýk Bilimleri Üniversitesi Bakýrköy Dr. Sadi Konuk Eðitim ve Araþtýrma Hastanesi, Radyoloji Kliniði, Ýstanbul
³TC. Saðlýk Bilimleri Üniversitesi Diyarbakýr Gazi Yaþargil Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reanimasyaon Kliniði, Diyarbakýr

Akut iskemik stroklu olguda mekanik trombektomi esnasýnda geliþen intrakranial hemorajiye nedenli Cushing refleksinin deðerlendirilmesi amaçlandý. Beþ saat önce geliþen sað yan güçsüzlüðü ve konuþma bozukluðu nedenli BT-anjiyo çekilen 59 yaþýnda erkek hastada sol MCA'da M1 segment oklüzyonu görüldü. Tedavi kararý hastaya mekanik trombektomi uygulanmasý oldu ve hasta giriþimsel nöroradiyoloji ünitesine sevk edildi. Genel anestezi altýnda prosedür olarak pýhtý lokalizasyonuna tromboaspirasyon kateterinin yerleþtirilmesi esnasýnda rutin bir þekilde teknik olarak ilerlendi, Ansýzýn bradikardi ve hipertansiyon geliþti ve anestezi ekibi 1 mg atropin uyguladý. Bradikardi ve hipertansiyonun infarktüslü bir hastada yapýlan mekanik trombektomiye baðlý olduðu düþünüldüðü için akut infarktüsten uzaklaþýldý. Eþ zamanlý kateterden kontrast madde verilerek MCA M1 segmentinde rüptür ve kontrast maddenin dýþarý sýzmasý görüldü. Sonuç olarak, anestezi ve operasyon ekibi tromboaspirasyon kateteri yerleþtirilmesi esnasýnda Cushing refleksi geliþtiði zaman damar perforasyonu açýsýndan uyanýk olmalýdýr.

Anahtar Kelimeler: Cushing refleksi, akut strok, mekanik trombektomi, genel anestezi, damar perforasyonu.

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