Abciximab Treatment Modalities for Thromboembolic Events Related to Aneurysm Coiling

Piérot, Laurent; Kadziolka, K.; Gomis, Philippe; Graftieaux, J.-P.

doi:10.1227/neu.0b013e3181f8d1db

Cited by 28 publications

(36 citation statements)

References 9 publications

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“…However, there is no consensus about when and how patients should be loaded with antiplatelet medication before the procedure. Glycoprotein IIb/IIIa antagonists have attracted attention for the prevention or treatment of thromboembolism during coiling of intracranial aneurysms, [5][6][7] but the increased risk of intracranial hemorrhage following glycoprotein IIb/IIIa inhibition remains a substantial concern. Moreover, the safety and efficacy data regarding the use of tirofiban in endovascular aneurysm treatment are lacking.…”

mentioning

confidence: 99%

Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Kim¹,

Choi²,

Kang³

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Stent-assisted coiling of intracranial aneurysms requires antiplatelet therapy, typically aspirin and clopidogrel to prevent thromboembolic complications. There is a substantial concern that tirofiban may increase the risk of hemorrhage when used as an antiplatelet premedication in ruptured intracranial aneurysms. Our aim was to evaluate the safety and efficacy of intravenous tirofiban administration, instead of oral dual antiplatelet agents, as an antiplatelet premedication for stent-assisted coiling in patients with acutely ruptured intracranial aneurysms.

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mentioning

confidence: 99%

Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Kim¹,

Choi²,

Kang³

et al. 2015

AJNR Am J Neuroradiol

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“…Many previous studies that have demonstrated high-infarct rates on postoperative imaging also highlight the fact that many of these infarcts are clinically silent. 1,2,9 We cannot evaluate infarct rates or success of recanalization with thrombolytic agents versus GpIIb/IIIa inhibitors in this study, but better outcomes suggest that GpIIb/IIIa inhibitors are a better option for rescue therapy. 15,16 …”

Section: Discussionmentioning

confidence: 95%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] The infarction rate among patients receiving rescue therapy ranges between 10% and 40% with higher rates generally seen in studies with postoperative MR imaging [1][2][3][4][5][6][7][8][9][10][11][12][13][14] ( Table 5). In a series of 477 patients with 515 intracranial aneurysms, Ries et al 1 reported that 48 patients (10%) had thromboembolic events; 42 of these patients received rescue therapy with GpIIbIIIa inhibitors, and 1 patient received rescue therapy with recombinant tissue plasminogen activator.…”

Section: Discussionmentioning

confidence: 99%

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Rescue Treatment of Thromboembolic Complications During Endovascular Treatment of Cerebral Aneurysms

Brinjikji

McDonald

Kallmes

et al. 2013

Stroke

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Background and Purpose-Acute intraprocedural thrombus formation complicating endovascular cerebral aneurysm treatment is often treated with intra-arterial or intravenous administration of thrombolytic agents or glycoprotein IIb/IIIa (GpIIb/IIIa) inhibitors. We sought to evaluate the morbidity and mortality associated with such treatments using a large multihospital database. Methods-Using the Premier Perspective Database, we examined outcomes for patients receiving endovascular coiling for ruptured and unruptured aneurysms requiring rescue therapy, defined as treatment with GpIIb/IIIa inhibitors and fibrinolytic therapy. We compared discharge status, length of stay, and complication rates across 3 groups: (1) patients receiving GpIIb/IIIa inhibitors only, (2) patients receiving fibrinolytic therapy only, and (3)

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“…They used combined IA and IV abciximab to treat the developing thrombi in 39 patients of whom 11 had ruptured aneurysms. They observed 56.5% complete recanalization, amelioration in the TIMI score in 73.9% yet no change was observed in 26.1% 9 .…”

Section: Casementioning

confidence: 94%

Rescue Stenting in Endovascular Treatment of Acutely Ruptured Cerebral Aneurysms

Mahmoud

2013

Interv Neuroradiol

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Thromboembolic events and major artery occlusion following cerebral aneurysm coiling may lead to serious complications and even death if not treated. The use of an intracranial stent in the setting of subarachnoid hemorrhage (SAH) is risky due to the need for antiplatelet therapy. However in some conditions it could be an effective solution for this major problem. This study describes a revascularization technique using a Solitaire stent for treatment of anterior cerebral artery (ACA) occlusion following coiling of anterior communicating artery (Acom) aneurysms. Three cases of ruptured Acom aneurysms treated during the course of SAH underwent unplanned deployment of an intracranial stent. Complete occlusion of the ACA at the origin of the A2 segment developed during or shortly after coiling. Emergent CT brain scan was done in two cases to exclude rebleeding. Follow-up CT or MRI scans were performed 24 hours after stenting. Technical success was achieved in all cases. Complete revascularization of the Acom was achieved post stent deployment (TIMI grade 3). Time from onset of symptoms to full revascularization in the three cases was 35 minutes, one hour 50 minutes and two hours 40 minutes respectively. No intracranial bleeding occurred in any case following the procedure. No neurological changes occurred in case 1; mild neurological and radiological changes occurred in cases 2 and 3. Deployment of an intracranial stent achieved complete revascularization of the occluded Acom. Its use in a context of SAH is relatively risky but the technique resulted in a significant improvement of symptoms following flow restoration and probably helped prevent symptoms worsening, major disability or even death. A study on a larger patient sample with long-term follow-up will be of value.

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Abciximab Treatment Modalities for Thromboembolic Events Related to Aneurysm Coiling

Abstract: Combined intra-arterial/intravenous administration of abciximab is safe and effective for treating thromboembolic complications that occur during aneurysmal coil embolization with no hemorrhagic complications.

Cited by 28 publications

References 9 publications

Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Rescue Treatment of Thromboembolic Complications During Endovascular Treatment of Cerebral Aneurysms

Rescue Stenting in Endovascular Treatment of Acutely Ruptured Cerebral Aneurysms

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