Post-Stroke Thrombectomy Evaluation: Expected Findings and Unexpected Complications

Acute ischemic stroke is a leading cause of morbidity and mortality requiring timely intervention. Mechanical thrombectomy is an increasingly prevalent technique for removal of the clot burden in patients with acute ischemic stroke with a targetable vessel, enabling treatment within 24 hours of symptom onset. In the post-mechanical thrombectomy period, patients must be monitored closely for complications and in preparation for secondary prevention therapy. Patients typically undergo serial follow-up imaging examinations with multiple modalities, including newer techniques such as dual-energy CT. The radiologist should be aware of the expected findings in the post-mechanical thrombectomy period, such as contrast material staining, and be able to distinguish these from complications. Post-mechanical thrombectomy complications can arise anywhere along the instrumentation path, involving both intracranial and extracranial findings. A conceptual understanding of the clinical implications of various complications is presented to help radiologists appropriately contextualize their findings at follow-up imaging. ^©RSNA, 2025 Supplemental material is available for this article.