• diagnostic DSA poses a low risk of complications (risk of neurological deficit ~ 0.09-0.14%)
    • risk increases in elderly patients with atherosclerotic disease of the aorta and carotid arteries
  • most of the complications listed below are related to interventional procedures (both acute and elective)
Central complications
  • artery/stent thrombosis, distal micro/macro embolization
  • hyperperfusion syndrome/hemorrhagic transformation (especially in recanalization procedures)
  • vasospasms
  • artery dissection/perforation
  • specific complications during angioplasty and stenting (stent malposition, deformation or rupture, etc.)
  • hypoperfusion (e.g. obstruction of distal filter protection with thrombi)
Peripheral (access-site) complications
  • femoral artery thrombosis
  • dissecting pseudoaneurysm or arterio-venous shunt in the groin
  • groin hematoma
  • retroperitoneal hematoma
Systemic complications

Central complications

Artery thrombosis, distal thromboembolism

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Integrilin
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Reopro
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Hemorrhagic infarction

ICH after mechanical thrombectomy

Hyperperfusion syndrome

  • occurs after acute recanalization procedures or after revascularisation of severe stenoses
    • edema, intracerebral or intraventricular hemorrhage, SAH
  • strict blood pressure control periprocedurally and in the following days is essential  Hyperperfusion syndrome with edema

hyperperfusion syndrome

Vasospasms

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Vasospasm in the M1 segment of the MCA and in terminal ICA
Vasospasms on DSA
ICA vasospasm occurring during the acute stroke endovascular procedure

Artery dissection/perforation

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Specific complications in stenting

Peripheral (access-site) complications

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Systemic complications

  Contrast agent related complications

Hemodynamic instability with hypoperfusion

  • hemodynamic depression has been reported both after carotid artery stenting (CAS) and carotid endarterectomy (CEA)
  • bradycardia with hypotension is usually a consequence of the carotid sinus manipulation (parasympathetic activation)
    • occurrence in varying severity in up to 42% of procedures [Gupta, 2006]
    • bradycardia is significantly influenced by the degree of dilation performed
    • the risk of delayed occurrence may justify a minimum of 12h postprocedural vital sign monitoring
  • severe bradycardia ⇒  administer ATROPIN 0.5 mg i.v
    • ATROPIN can also be given prophylactically in these cases:
      • severely calcified stenoses
      • lesions in the carotid bulb
      • history of MI
  • moderate or severe hypotension ⇒ consider vasopressors + fluids
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