NEUROIMAGING
Complications of endovascular procedures
Created 14/05/2021, last revision 02/04/2023
- diagnostic DSA carries a low risk of complications (risk of neurological deficit ~ 0.09-0.14%)
- the 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 thrombosis, distal thromboembolism
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Hemorrhagic infarction
- bleeding most commonly occurs during reperfusion procedures in patients with concurrent extensive early ischemia (low ASPECT score)
- petechial hemorrhage/parenchymal hematoma → classification of hemorrhagic complications
- hemorrhagic transformation of ischemia may be associated 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
Vasospasms
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Artery dissection/perforation
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Stenting-related complications
Peripheral (access-site) complications
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Systemic complications
Complications related to contrast media
Hemodynamic instability with hypoperfusion
- hemodynamic depression has been reported after both carotid artery stenting (CAS) and carotid endarterectomy (CEA)
- bradycardia with hypotension is usually a consequence of carotid sinus manipulation (parasympathetic activation)
- severe bradycardia ⇒ administer ATROPIN 0.5 mg IV
- ATROPIN can also be given prophylactically in the following cases:
- severely calcified stenoses
- lesions in the carotid bulb
- history of myocardial infarction
- ATROPIN can also be given prophylactically in the following cases:
- moderate or severe hypotension ⇒ consider vasopressors + fluids