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Abstract
Multiple randomized clinical trials have supported the use of mechanical thrombectomy (MT) as standard of care in the treatment of large vessel occlusion acute ischemic stroke. Optimal outcomes depend not only on early reperfusion therapy but also on post thrombectomy care. Early recognition of post MT complications including reperfusion hemorrhage, cerebral edema and large space occupying infarcts, and access site complications can guide early initiation of lifesaving therapies that can improve neurologic outcomes. Knowledge of common complications and their management is essential for stroke neurologists and critical care providers to ensure optimal outcomes. We present a review of the available literature evaluating the common complications in patients undergoing MT with emphasis on early recognition and management.
Glossary
- AQP4=
- aquaporin 4;
- ASPECTS=
- Alberta Stroke Program Early CT Score;
- BBB=
- blood-brain barrier;
- BP=
- blood pressure;
- BPV=
- blood pressure variability;
- CBF=
- cerebral blood flow;
- DBP=
- diastolic blood pressure;
- ECASS=
- European Cooperative Acute Stroke Study;
- HBC=
- Heidelberg Bleeding Classification;
- HI=
- hemorrhagic infarction;
- HT=
- hemorrhagic transformation;
- ICH=
- intracerebral hemorrhage;
- ICP=
- intracranial pressure;
- ICU=
- intensive care unit;
- LVO=
- large vessel occlusion;
- MCA=
- middle cerebral artery;
- MMP=
- matrix metalloproteinase;
- mRS=
- modified Rankin Scale;
- MT=
- mechanical thrombectomy;
- NIHSS=
- National Institutes of Health Stroke Scale;
- NNT=
- number needed to treat;
- PH=
- parenchymal hematoma;
- PWI=
- perfusion-weighted MRI;
- rtPA=
- recombinant tissue plasminogen activator;
- SAH=
- subarachnoid hemorrhage;
- SBP=
- systolic blood pressure;
- sICH=
- symptomatic intracerebral hemorrhage;
- TCD=
- transcranial Doppler
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this article.
- Received June 28, 2020.
- Accepted in final form June 23, 2021.
- © 2021 American Academy of Neurology
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