Table 2.

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

Complication		% in RCTs	Prevention	Management
Extracranial or access site	Groin hematoma	2–10%3 4 6 8	Vascular access under ultrasound guidance	Watchful observation Thrombin injection Implantation of covered stents
	Vasospasm	3,9–23%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!
	Dissection	0,6–3,9%2 3 6	Evaluation of access vessel anatomy prior to intervention to plan approach	Watchful observation In cases of increasing stenosis stent placement
Hemorrhagic	Vessel perforation	0,6–4,9%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
Ischemic	Distal embolization	4–6%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.