Principles for Complication Avoidance and Management in Thrombectomy for Ischemic Stroke

Endovascular thrombectomy has achieved a dramatical shift in our management strategies for ischemic stroke. With the benefits of increased reperfusion rates and improved outcomes, endovascular thrombectomy represents a significant improvement to the available management approaches. The cornerstone of this technique resides in its ability to achieve rapid recanalization of occluded vessels by direct removal of the occluding thrombus. Because of its endovascular nature, several complications can accompany the procedure. The most common associated complications include intracranial hemorrhage, vasospasm, and distal embolization. Other procedure-related complications accompany the endovascular approach and thus been recognized more recently, including arterial dissection and inadvertent thrombectomy device detachment. The severity can range widely, and the clinician must be familiar with these complications and the available management options when performing the endovascular thrombectomy procedure. This chapter will review the common complications, familiarize the reader with avoidance techniques, and discuss the current management options.