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

Balami, Joyce, White, Philip, McMeekin, Peter, Ford, Gary and Buchan, Alastair (2018) Complications of endovascular treatment for acute ischemic stroke: Prevention and management. International Journal of Stroke, 13 (4). pp. 348-361. ISSN 1747-4930

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Endovascular mechanical thrombectomy (MT) for the treatment of acute stroke due to large vessel occlusion has evolved significantly with the publication of multiple positive thrombectomy trials. MT is now a recommended treatment for acute ischemic stroke. Mechanical thrombectomy is associated with a number of intra-procedural or post-operative complications, which need to be minimized and effectively managed to maximize the benefits of thrombectomy. Procedural complications include: access-site problems (vessel/nerve injury, access-site hematoma and groin infection); device-related complications (vasospasm, arterial perforation and dissection, device detachment/misplacement); symptomatic intracerebral hemorrhage; subarachnoid hemorrhage; embolization to new or target vessel territory. Other complications include: anesthetic/contrast-related, post-operative hemorrhage, extra-cranial hemorrhage and pseudoaneurysm. Some complications are life-threatening and many lead to increased length of stay in intensive care and stroke units. Complications increase costs and delay the commencement of rehabilitation. Some may be preventable; the impact of others can be minimized with early detection and appropriate management. Both neurointerventionists and stroke specialists need to be aware of the risk factors, strategies for prevention, and management of these complications. With the increasing use of mechanical thrombectomy for the treatment of acute ischemic stroke, incidence and outcome of complications will need to be carefully monitored by stroke teams. In this narrative review, we examine the frequency of complications of MT in the treatment of acute ischemic stroke with an emphasis on periprocedural complications. Overall, from recent randomized controlled trials, the risk of complications with sequelae for patient from mechanical thrombectomy is ∼15%. We discuss the management of complications and identify areas with limited evidence, which need further research.

Item Type: Article
Uncontrolled Keywords: Acute ischemic stroke, acute stroke therapy, complications of endovascular mechanical thrombectomy, endovascular mechanical thrombectomy, management of complications, prevention of complications
Subjects: B100 Anatomy, Physiology and Pathology
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: Becky Skoyles
Date Deposited: 15 Jan 2018 13:05
Last Modified: 11 Oct 2019 20:00

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