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Review
. 2020 Jun;37(2):199-200.
doi: 10.1055/s-0040-1709206. Epub 2020 May 14.

Endovascular Stroke Interventions: Procedural Complications and Management

Ahmed Elakkad  1 , Gerald Drocton  1 , Ferdinand Hui  1
Affiliations
Review

Endovascular Stroke Interventions: Procedural Complications and Management

Ahmed Elakkad et al. Semin Intervent Radiol. 2020 Jun.

Abstract

Endovascular mechanical thrombectomy has evolved significantly and has become the mainstay and most effective currently available treatment for acute ischemic stroke patients due to large vessel occlusion. Mechanical thrombectomy is presently performed using a stent retriever or stent-like device, an aspiration catheter, or a combination of the two. Much of the literature has focused on the benefits of endovascular mechanical thrombectomy with only limited data about procedural complications and management. Awareness of risk factors and early recognition of these complications can potentially reduce complication rates, improve management, and yield better overall outcomes. In this review, the authors present a description of intraprocedural complications and strategies to prevent and treat these complications.

Keywords: complication; hemorrhage; interventional radiology; stent; stroke.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
( a ) Digital subtraction angiography (DSA) of the right external iliac artery (EIA) via a left femoral approach anteroposterior view showing a pseudoaneurysm adjacent to the distal tip of the sheath (arrow) with early opacification of the external iliac vein, consistent with arteriovenous fistula (asterisk). ( b ) DSA of the right EIA revealing complete obliteration of aneurysm and the fistula after deploying a Viabahn Gore covered stent across the neck of the aneurysm.
Fig. 2
Fig. 2
( a ) Digital subtraction angiography (DSA) of the right common carotid artery, right anterior oblique view showing total internal carotid artery (ICA) origin occlusion after microcatheter and a wire were successfully advanced through the occlusion. ( b ) DSA run of the right ICA, lateral view after reperfusion of the intracranial vessels showing a linear/spiral filling defect within the petrocavernous segment of the ICA consistent of dissection. ( c ) Repeat angiography 7 days after the procedure showing complete resolution of the dissection with preserved antegrade flow.
Fig. 3
Fig. 3
( a ) Digital subtraction angiography (DSA) of the left internal carotid artery (ICA), Towne view showing occluded left middle cerebral artery (MCA) with anterior cerebral artery pial collaterals retrogradely filling the distal MCA territory. ( b ) Microcatheter DSA run of the MCA after first pass using stent retrieval device (Solitaire) revealing contrast extravasation at the distal MCA. ( c ) Guide catheter DSA run of the left ICA showing occluded MCA sealing the microperforation. The presence of collaterals suggests acute on top of chronic occlusion or long-term MCA stenosis.
Fig. 4
Fig. 4
Flow chart for procedural complications and management.
Fig. 5
Fig. 5
Flow chart for procedural complications and management.
See this image and copyright information in PMC

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