Cerebral Angiography Can Demonstrate Changes in Collateral Flow During Induced Hypertension

Area of Science:

• Neurology
• Interventional Neuroradiology

Background:

• Mechanical clot retrieval is a standard treatment for acute ischemic stroke.
• Endovascular treatment decisions are based on risk assessment and patient factors.

Observation:

• A 52-year-old woman presented with a large left-hemispheric stroke and M1-segment left middle cerebral artery occlusion 7 hours post-symptom onset.
• Mechanical clot retrieval was deemed high-risk; therefore, induced hypertension was initiated via neosynephrine infusion.

Findings:

• Induced hypertension resulted in enhanced collateralization to the middle cerebral artery territory from anterior cerebral artery branches.
• Mean transit time (MTT) improved from 9.5 to 6.0 seconds, indicating better cerebral blood flow.
• Continuous neosynephrine infusion for 24 hours led to significant neurological improvement.

Implications:

• Induced hypertension may be a viable alternative treatment for select stroke patients unsuitable for mechanical thrombectomy.
• Augmentation of leptomeningeal collaterals via induced hypertension can improve clinical outcomes in acute ischemic stroke.
• Further research is warranted to explore the role and safety of induced hypertension in stroke management.