Neuroendovascular interventions have provided significant advances in the treatment of cerebrovascular diseases, particularly acute ischemic stroke and intracranial aneurysms. However, due to their inherent nature, these procedures carry a substantial risk of vascular complications. Reported perioperative complication rates associated with neuroendovascular treatments range between 4% and 29%. Awareness of these risks, early recognition, appropriate management, and implementation of preventive strategies are critical for improving clinical outcomes.
The overall complication risk varies according to the interventional technique, devices used, and patient-specific vascular anatomy. Commonly reported complications include distal embolization, de novo stenosis, vessel perforation, dissection, vasospasm, and access site–related hematomas. Certain endovascular modalities, particularly flow-diverting stents, are associated with an increased risk of systemic hemorrhagic complications due to the requirement for dual antiplatelet therapy.
Vascular complications occurring during neuroendovascular procedures are broadly classified as intracranial or extracranial. Intracranial complications are further categorized into hemorrhagic, ischemic, and mechanical or structural subtypes. Vessel perforation or rupture resulting in subarachnoid or intracerebral hemorrhage represents the most severe complications with significant clinical consequences. Thrombus fragmentation, procedure-related arterial occlusion, and hemodynamic compromise constitute the principal mechanisms underlying ischemic complications. Extracranial complications are predominantly related to femoral or radial vascular access.
Vascular complications adversely affect mortality, morbidity, intensive care unit stay, and rehabilitation duration. Intracranial vessel perforation, in particular, is associated with high mortality and severe disability. Prevention of complications relies on meticulous device manipulation, appropriate access techniques, ultrasound-guided vascular puncture, and the presence of experienced operators.