ABSTRACT
The goal of endovascular therapy in the treatment of cerebrovascular disease is to modify the disease state in order to decrease the risk of subsequent brain injury or death. The performance of endovascular therapy for cerebrovascular disease is associated with risks for brain injury and death due to unintended complications. The formation of thrombus and/or distal embolization of thrombus or atheromatous tissue into the cerebrovascular arterial system can result in brain injury or death. The cause of unintended thrombosis in the setting of endovascular therapy for cerebrovascular disease is best understood by recalling Virchow’s classic triad. Virchow initially described the classic triad of conditions predisposing to the formation of intravascular thrombosis (originally in veins): stasis of blood flow, endothelial injury, and hypercoagulable states. Obviously, if an intravascular thrombus is occlusive or near occlusive to blood flow, this will result in brain injury, and depending upon the extent and severity of the brain injury, potentially death. Embolism is the movement of material which may consist of thrombus, atheromatous debris, or other tissue from an upstream location in an artery to a downstream location where it ultimately lodges. The ultimate distal destination of the embolic material and the degree of occlusion of the blood vessel at its destination will determine the extent and severity of brain injury that results. It is easy to understand that during the manipulation of endovascular devices in the vascular space that operator-induced movement of such devices can dislodge an existing thrombus or atheromatous tissue or other tissue. It is also easy to understand how body motion including pulsatile hemodynamics of blood flow can dislodge endovascular devices or existing thrombus that formed as a result of manipulating an endovascular device. This section will review
the cause and incidence of thrombotic and embolic complications of endovascular treatment of cerebrovascular disease. This section will also briefly review the prevention, detection, and treatment of thrombotic and embolic complications of endovascular treatment of cerebrovascular disease.
