Periprocedural complications in endovascular stroke treatment

Abstract

Endovascular stroke treatment is a neurointerventional emergency where the main goal is the early recanalization of the occlusion within the critical time window, as safely as possible. Although the time window and rate of complications for endovascular stroke treatment differ with anterior and posterior circulation strokes, awareness of potential periprocedural complications is important, as they affect patient morbidity and mortality. Periprocedural complications are classified as haemorrhagic complications, procedure-/device-related, puncture site complications, and late-onset events including vascular stenosis. We present the digital subtraction angiography and CT imaging findings related to these complications in a study of 56 stroke patients, as they relate to previous findings in the literature.

Complications of endovascular treatment for acute ischemic stroke: Prevention and management

“…Akpinar and colleagues (2016) 20 reported one case of AP that was caused by microguidewire while trying to gain access through an occluded MCA. Leishangthem et al, 2014 reported a case of AP that occurred during withdrawal of the stentriever.…”

“…38 If the bleeding persists after a period of balloon inflation (5-10 minutes), injection of liquid embolic agents (NBCA or Onyx) or insertion of detachable coils can be used to occlude the damaged arterial segment. 20,38 There will be the need for subsequent radiological imaging to monitor for potential development of pseudoaneurysm at the site of perforation and thromboembolic complications. 40 Clearly parent artery occlusion in these circumstances will often result in major stroke with attendant risks of severe disability, requirement for hemicraniectomy or perioperative death (with potential medicolegal consequences -in the UK at least).…”

“…Vasospasm usually results from "irritation" of the vessels by catheter manipulation during thrombectomy, 20 it can also involve the vessels at the access site. 23 Behme and colleagues reported vasospasm of access vessels in five of 176 patients (3%).…”

“…There are limited recent publications on the complications and their management. [20][21][22][23][24] This review examines complications from the recent RCTs and non-RCTs with an exclusive focus on the new-generation thrombectomy devices from studies published in the last four years, with the aim of increasing awareness of complications and highlighting approaches to reduce their incidence and improve their prevention and management; NB. obsolete devices/techniques are not considered in this review.…”

Intra-Arterial Thrombectomy in the Management of Acute Ischemic Stroke: Evidentiary Analysis Over the Past Two Years

“…The outcomes such as quality of life Regarding the occurrence of atypical events and complications related to the procedure, the leading event was puncture site complications, followed by hemorrhagic events (hemorrhagic infarction or parenchymal hematoma), procedure-/device-related events (such as stent detachment, arterial dissection and vascular perforation) and late-onset occurrences (vascular stenosis, usually asymptomatic) 17 . Hemodynamic variables are clearly related to more severe outcomes, especially with huge variability in blood pressure and hypotension.…”