Measurement of Intracranial Arterial Wedge Pressure in Cases of Major Cerebral Arterial Occlusion

Abstract

We considered wedge pressure might be a good indicator for the residual cerebral blood flow in cases of acute cerebral arterial occlusion. It was measured in eight cases of acute major cerebral arterial occlusion (seven MCA or MCA branch occlusion, one intracranial ICA occlusion) by navigating a microcatheter beyond the clot. It varied from 8 to 40 mmHg. All cases were treated by superselective infusion of the thrombolytic agent (six cases, tissue plasminogen activator; two cases, urokinase) following measurement of the wedge pressure. Three of them were completely recanalized and patients recovered with minimum neurological deficit. Two cases resulted in cerebral infarction in spite of partial recanalization. The other three non-recanalized cases within six hours also resulted in cerebral infarction, which was confirmed on CT immediately after treatment. A case of wedge pressure 33 mmHg tolerated 4 hours ischemia and other case of wedge pressure 40 mmHg tolerated 24 hours ischemia. Cases with wedge pressure lower than 35 mmHg could not tolerate 6 hours ischemia. Arterial wedge pressure distal to the clot supposed to be a good indicator of residual cerebral blood flow and useful for the determination of the thrombolytic therapy.