Complications of endovascular therapy in acute ischemic stroke

Abstract Background Mechanical thrombectomy (MT) is considered the key approach for managing acute ischemic stroke of large vessel occlusion (LVO) origin. However, real-world data on procedural, neurological, and medical complications remain limited. This study seeks to assess the frequency, spectrum, and potential predictors of complications associated with endovascular MT in routine clinical practice. Methods This prospective single-center cohort study included patients with acute ischemic stroke due to LVO who underwent MT between July 2023 and July 2025. Eligible patients had radiological evidence of LVO and an ASPECTS ≥ 6 within standard or extended time windows. Clinical, radiological, and procedural variables were recorded. Recanalization was graded using the modified Thrombolysis in Cerebral Infarction (mTICI) score. Complications were systematically documented and compared between patients with and without complications. Results Thirty-four patients were included (mean age 63.4 ± 11.2 years; 58.8% male). Successful reperfusion (mTICI 2B–3) was achieved in 94.2% of cases, with complete reperfusion (mTICI 3) in 61.8%. Post-procedural complications were common, most frequently pneumonia (23.5%), groin hematoma (11.8%), and cardiac insufficiency (11.8%). Symptomatic intracerebral hemorrhage occurred in 5.9%. Patients with complications were older, had higher baseline NIHSS scores, more vascular risk factors, and longer groin puncture-to-recanalization times. All deaths (8.8%) occurred in the complication group. Conclusion Despite high reperfusion rates, MT is associated with a broad range of complications. Medical complications were prevalent, particularly pneumonia, with a potential association with baseline stroke severity and the procedure duration. Further trials with a direct control group and a rigorous design are needed to validate these findings.