Cerebral hyperperfusion syndrome after mechanical thrombectomy

A male patient in his late 50s who had untreated atrial fibrillation received mechanical thrombectomy for right middle cerebral artery occlusion (MCA), with complete recanalization. After initial neurological improvement, he developed headache and altered vigilance 2 days post-thrombectomy. Transcranial duplex sonography (TCD) showed increased blood flow velocities in the entire ipsilateral (recanalized) MCA-M1 segment.1 2 Brain MRI with angiography excluded focal stenosis and showed vasogenic edema, hemorrhagic transformation of the ischemic infarct, and cerebral hyperperfusion in the right MCA territory (figure 1). Because of this finding, the patient underwent intense blood pressure (BP) control (systolic BP target …