Table 2

Summary of stroke thrombectomy complications (% in randomized controlled trials), their prevention, and management suggestions

Complication% in RCTsPreventionManagement
Extracranial or access siteGroin hematoma2–10%3 4 6 8 Vascular access under ultrasound guidance
  • Watchful observation

  • Thrombin injection

  • Implantation of covered stents

Vasospasm3,9–23%5 6 8 If anticipated or seen early, injection of a calcium blocker such as nimodipine (0.5–1 mg/500 mL infusion) through the flushing line of the guiding catheter might help
  • Selective injection of a calcium blocker such as nimodipine as a bolus

  • Selective injection of a calcium blocker such as nimodipine (0.5–1 mg/500 mL infusion) through the flushing line of the guiding catheter

  • BEWARE: can cause hypotension and steal phenomena!

Dissection0,6–3,9%2 3 6 Evaluation of access vessel anatomy prior to intervention to plan approach
  • Watchful observation

  • In cases of increasing stenosis stent placement

HemorrhagicVessel perforation0,6–4,9%2–6 J-shaped microwire, passing thrombus with microcatheter only, unsheathing rather than pushing a stent retriever
  • Do not pull back the perforating device

  • Reduce blood pressure temporarily

  • Deploy a coil temporarily

  • Prepare a balloon to inflate

  • Balloon inflation (5–10 min)

  • LAST: permanent occlusion by detaching coils or liquid embolic agent

IschemicDistal embolization4–6%40 Flow-arrest devices—for example, balloon-guide catheters, distal aspiration catheters
  • If affected vessel is eloquent consider endovascular thrombectomy again

  • In cases of inaccessibility of distal emboli intra-arterial thrombolysis using urokinase or rtPA can be considered

De novo stenosis of target vessel
(long term)
3,4%51 Antiplatelet therapy as secondary prevention after stroke treatment, follow-up imaging to monitor long-term complications
  • Depending on grade of stenosis, clinical relevance, and cause, endovascular re-treatment might be necessary

  • rtPA, recombinant tissue plasminogen activator.