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DOI: 10.1055/s-0040-1709206
Endovascular Stroke Interventions: Procedural Complications and Management
Publication History
Publication Date:
14 May 2020 (online)
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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.
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References
- 1 Balami JS, White PM, McMeekin PJ, Ford GA, Buchan AM. Complications of endovascular treatment for acute ischemic stroke: Prevention and management. Int J Stroke 2018; 13 (04) 348-361
- 2 Church EW, Gundersen A, Glantz MJ, Simon SD. Number needed to treat for stroke thrombectomy based on a systematic review and meta-analysis. Clin Neurol Neurosurg 2017; 156: 83-88
- 3 Shah VA, Martin CO, Hawkins AM, Holloway WE, Junna S, Akhtar N. Groin complications in endovascular mechanical thrombectomy for acute ischemic stroke: a 10-year single center experience. J Neurointerv Surg 2016; 8 (06) 568-570
- 4 Alawieh A, Vargas J, Fargen KM. , et al. Impact of procedure time on outcomes of thrombectomy for stroke. J Am Coll Cardiol 2019; 73 (08) 879-890
- 5 Haussen DC, Nogueira RG, DeSousa KG. , et al. Transradial access in acute ischemic stroke intervention. J Neurointerv Surg 2016; 8 (03) 247-250
- 6 Mokin M, Snyder KV, Levy EI, Hopkins LN, Siddiqui AH. Direct carotid artery puncture access for endovascular treatment of acute ischemic stroke: technical aspects, advantages, and limitations. J Neurointerv Surg 2015; 7 (02) 108-113
- 7 Wu CJ, Cheng CI, Hung WC. , et al. Feasibility and safety of transbrachial approach for patients with severe carotid artery stenosis undergoing stenting. Catheter Cardiovasc Interv 2006; 67 (06) 967-971
- 8 Jadhav AP, Ribo M, Grandhi R. , et al. Transcervical access in acute ischemic stroke. J Neurointerv Surg 2014; 6 (09) 652-657
- 9 Akins PT, Amar AP, Pakbaz RS, Fields JD. ; SWIFT Investigators. Complications of endovascular treatment for acute stroke in the SWIFT trial with solitaire and Merci devices. AJNR Am J Neuroradiol 2014; 35 (03) 524-528
- 10 Goyal M, Demchuk AM, Menon BK. , et al; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372 (11) 1019-1030
- 11 Campbell BC, Mitchell PJ, Kleinig TJ. , et al; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372 (11) 1009-1018
- 12 Jovin TG, Chamorro A, Cobo E. , et al; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372 (24) 2296-2306
- 13 Bracard S, Ducrocq X, Mas JL. , et al; THRACE Investigators. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol 2016; 15 (11) 1138-1147
- 14 Nikoubashman O, Jungbluth M, Schürmann K. , et al. Neurothrombectomy in acute ischaemic stroke: a prospective single-centre study and comparison with randomized controlled trials. Eur J Neurol 2016; 23 (04) 807-816
- 15 Serles W, Gattringer T, Mutzenbach S. , et al; Austrian Stroke Unit Registry Collaborators. Endovascular stroke therapy in Austria: a nationwide 1-year experience. Eur J Neurol 2016; 23 (05) 906-911
- 16 Weber R, Nordmeyer H, Hadisurya J. , et al. Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis. J Neurointerv Surg 2017; 9 (03) 229-233
- 17 Seto AH, Abu-Fadel MS, Sparling JM. , et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial). JACC Cardiovasc Interv 2010; 3 (07) 751-758
- 18 Sanborn TA, Ebrahimi R, Manoukian SV. , et al. Impact of femoral vascular closure devices and antithrombotic therapy on access site bleeding in acute coronary syndromes: The Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. Circ Cardiovasc Interv 2010; 3 (01) 57-62
- 19 Smilowitz NR, Kirtane AJ, Guiry M. , et al. Practices and complications of vascular closure devices and manual compression in patients undergoing elective transfemoral coronary procedures. Am J Cardiol 2012; 110 (02) 177-182
- 20 Arora N, Matheny ME, Sepke C, Resnic FS. A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices. Am Heart J 2007; 153 (04) 606-611
- 21 Sheth RA, Walker TG, Saad WE. , et al; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for vascular access and closure device use. J Vasc Interv Radiol 2014; 25 (01) 73-84
- 22 Kosmidou I, Karmpaliotis D. . Vascular complications after percutaneous coronary intervention. In: Jeremias A, Brown DL. , eds. Cardiac Intensive Care, 2nd ed. Philadelphia, PA: W.B. Saunders; 2010: 270-274
- 23 Mishra A, Rao A, Pimpalwar Y. Ultrasound guided percutaneous injection of thrombin: effective technique for treatment of iatrogenic femoral pseudoaneurysms. J Clin Diagn Res 2017; 11 (04) TC04-TC06
- 24 Thavarajan D, Bakran A. Iatrogenic arteriovenous fistula in the groin presenting as cardiac failure. NDT Plus 2009; 2 (01) 46-48
- 25 Davis MC, Deveikis JP, Harrigan MR. Clinical presentation, imaging, and management of complications due to neurointerventional procedures. Semin Intervent Radiol 2015; 32 (02) 98-107
- 26 Berkhemer OA, Fransen PS, Beumer D. , et al; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372 (01) 11-20
- 27 Goeggel Simonetti B, Hulliger J, Mathier E. , et al. Iatrogenic vessel dissection in endovascular treatment of acute ischemic stroke. Clin Neuroradiol 2019; 29 (01) 143-151
- 28 Akpinar SH, Yilmaz G. Periprocedural complications in endovascular stroke treatment. Br J Radiol 2016; 89 (1057): 20150267
- 29 Papanagiotou P, White CJ. Endovascular reperfusion strategies for acute stroke. JACC Cardiovasc Interv 2016; 9 (04) 307-317
- 30 Ishihara H, Ishihara S, Niimi J. , et al. Risk factors and prevention of guiding catheter-induced vasospasm in neuroendovascular treatment. Neurol Med Chir (Tokyo) 2015; 55 (03) 261-265
- 31 Behme D, Gondecki L, Fiethen S, Kowoll A, Mpotsaris A, Weber W. Complications of mechanical thrombectomy for acute ischemic stroke-a retrospective single-center study of 176 consecutive cases. Neuroradiology 2014; 56 (06) 467-476
- 32 Saver JL, Goyal M, Bonafe A. , et al; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372 (24) 2285-2295
- 33 Bauer AM, Rasmussen PA. Treatment of intracranial vasospasm following subarachnoid hemorrhage. Front Neurol 2014; 5: 72-72
- 34 Masoud H, Nguyen TN, Martin CO. , et al. Inadvertent stent retriever detachment: a multicenter case series and review of device experience FDA reports. Intervent Neurol 2016; 4 (3-4): 75-82
- 35 Youn SW, Kim HK. Refinement of a thrombectomy technique to treat acute ischemic stroke: technical note on microcatheter advance during retrieving self-expandable stent. J Korean Soc Radiol 2012; 67 (01) 1-6
- 36 Liu KC, Ding D, Starke RM, Geraghty SR, Jensen ME. Intraprocedural retrieval of migrated coils during endovascular aneurysm treatment with the Trevo Stentriever device. J Clin Neurosci 2014; 21 (03) 503-506
- 37 Kabbani MR, Smith A, Leider M. Endovascular coil retrieval using a TrevoProVue stentriever. BMJ Case Rep 2014; 2014: 201
- 38 Yub Lee S, Won Youn S, Kyun Kim H, Rok Do Y. Inadvertent detachment of a retrievable intracranial stent: review of manufacturer and user facility device experience. Neuroradiol J 2015; 28 (02) 172-176
- 39 Moshayedi P, Jadhav AP. Direct aspiration catheter fracture and retrieval during neurothrombectomy. Intervent Neurol 2018; 7 (3-4): 148-152
- 40 Mokin M, Fargen KM, Primiani CT. , et al. Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes. J Neurointerv Surg 2017; 9 (10) 922-928
- 41 Leishangthem L, Satti SR. Vessel perforation during withdrawal of Trevo ProVue stent retriever during mechanical thrombectomy for acute ischemic stroke. J Neurosurg 2014; 121 (04) 995-998
- 42 Maus V, Brehm A, Tsogkas I, Henkel S, Psychogios MN. Stent retriever placement in embolectomy: the choice of the post-bifurcational trunk influences the first-pass reperfusion result in M1 occlusions. J Neurointerv Surg 2019; 11 (03) 237-240
- 43 Doerfler A, Wanke I, Egelhof T. , et al. Aneurysmal rupture during embolization with Guglielmi detachable coils: causes, management, and outcome. AJNR Am J Neuroradiol 2001; 22 (10) 1825-1832
- 44 Nimmo G, Howie A, Grant I. Effects of mechanical ventilation on Cushing's triad. Crit Care 2009; 13 (Suppl. 01) P77
- 45 Layton KF, Cloft HJ, Kallmes DF. Cerebral aneurysm perforations during treatment with detachable coils. Use of remodelling balloon inflation to achieve hemostasis. Interv Neuroradiol 2006; 12 (01) 31-35
- 46 Farhat HI, Elhammady MS, Aziz-Sultan MA. N-Butyl-2-cyanoacrylate use in intraoperative ruptured aneurysms as a salvage rescue: case report. Neurosurgery 2010; 67 (01) 216-217 , discussion 217
- 47 Nguyen TN, Lanthier S, Roy D. Iatrogenic arterial perforation during acute stroke interventions. AJNR Am J Neuroradiol 2008; 29 (05) 974-975
- 48 Chueh JY, Puri AS, Wakhloo AK, Gounis MJ. Risk of distal embolization with stent retriever thrombectomy and ADAPT. J Neurointerv Surg 2016; 8 (02) 197-202
- 49 Lapergue B, Blanc R, Gory B. , et al; ASTER Trial Investigators. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial. JAMA 2017; 318 (05) 443-452
- 50 Stampfl S, Pfaff J, Herweh C. , et al. Combined proximal balloon occlusion and distal aspiration: a new approach to prevent distal embolization during neurothrombectomy. J Neurointerv Surg 2017; 9 (04) 346-351
- 51 Darkhabani Z, Nguyen T, Lazzaro MA. , et al. Complications of endovascular therapy for acute ischemic stroke and proposed management approach. Neurology 2012; 79 (13) (Suppl. 01) S192-S198
- 52 Yilmaz R, Yuksekbas O, Erkol Z, Bulut ER, Arslan MN. Postmortem findings after anaphylactic reactions to drugs in Turkey. Am J Forensic Med Pathol 2009; 30 (04) 346-349
- 53 Brown SG. Cardiovascular aspects of anaphylaxis: implications for treatment and diagnosis. Curr Opin Allergy Clin Immunol 2005; 5 (04) 359-364
- 54 Grunau BE, Wiens MO, Rowe BH. , et al. Emergency department corticosteroid use for allergy or anaphylaxis is not associated with decreased relapses. Ann Emerg Med 2015; 66 (04) 381-389
- 55 Fiehler J, Cognard C, Gallitelli M. , et al. European Recommendations on Organisation of Interventional Care in Acute Stroke (EROICAS). Int J Stroke 2016; 11 (06) 701-716
- 56 White PM, Bhalla A, Dinsmore J. , et al. Standards for providing safe acute ischaemic stroke thrombectomy services (September 2015). Clin Radiol 2017; 72 (02) 175.e1-175.e9
- 57 Soize S, Barbe C, Kadziolka K, Estrade L, Serre I, Pierot L. Predictive factors of outcome and hemorrhage after acute ischemic stroke treated by mechanical thrombectomy with a stent-retriever. Neuroradiology 2013; 55 (08) 977-987
- 58 Jiang S, Fei A, Peng Y. , et al. Predictors of outcome and hemorrhage in patients undergoing endovascular therapy with solitaire stent for acute ischemic stroke. PLoS One 2015; 10 (12) e0144452
- 59 Baek JH, Kim BM, Heo JH. , et al. Number of stent retriever passes associated with futile recanalization in acute stroke. Stroke 2018; 49 (09) 2088-2095
- 60 Kharouba R, Gavriliuc P, Yaghmour NE, Gomori JM, Cohen JE, Leker RR. Number of stentriever passes and outcome after thrombectomy in stroke. J Neuroradiol 2019; 46 (05) 327-330
- 61 Bourcier R, Saleme S, Labreuche J. , et al; ASTER Trial Investigators. More than three passes of stent retriever is an independent predictor of parenchymal hematoma in acute ischemic stroke. J Neurointerv Surg 2019; 11 (07) 625-629