Complications of endovascular procedures

Artery thrombosis, distal thromboembolism

Hemorrhagic infarction

• bleeding occurs most often during reperfusion procedures in the patient with concurrent extensive early ischemia
  • petechial hemorrhage/parenchymal hematoma  → classification of hemorrhagic complications
  • possibly in combination with intraventricular bleeding or SAH
• clinically symptomatic x asymptomatic
• if detected, neutralize heparin → see here
• in patients on DAPT or patients treated with an IIb/IIIa inhibitor, administer platelets and SOLUMEDROL 25mg i.v. (if the patient is on clopidogrel) [Qureshi, 2008]     → neutralizing effect of antiplatelet therapy

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

Vasospasms

Artery dissection/perforation

Specific complications in stenting

→ see here

Contrast agent related complications

• contrast-induced nephropathy (CIN)
• contrast-induced encephalopathy (CIE)

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