Glycoprotein IIb/IIIa antagonists during carotid artery stenting:

Zahn, Ralf; Ischinger, Thomas; Hochadel, Matthias; Mark, Bernd; Zeymer, Uwe; Jung, Jens; Schramm, Alexander; Hauptmann, Karl-Eugen; Seggewiß, Hubert; Janicke, Ilse; Mudra, Harald; Senges, Jochen

doi:10.1007/s00392-007-0551-7

Cited by 21 publications

(5 citation statements)

References 28 publications

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“…Despite the intraoperative use of cerebral umbrella, perioperative use of antiplatelet aggregation drugs, and no balloon dilation after stent implantation, there was still one patient with acute ischemic stroke aggravation after surgery, and no signi cant large vessel occlusion was found in reexamination of the angiography, which was considered as perforator artery occlusion. The use of cerebral umbrella can effectively reduce the occurrence of cerebral infarction after CAS surgery [22,23], but there is no consensus on whether tiro ban and other antiplatelet drugs should be routinely used [24]. Perhaps preoperative cervical vascular color ultrasound and magnetic resonance vascular plaque imaging should be used to determine whether it is vulnerable plaque, in order to conduct targeted preventive treatment [25].…”

Section: Discussionmentioning

confidence: 99%

HDL can predict the treatment of hypotension after CAS surgery for initial internal carotid artery stenosis

Ma,

Yang,

et al. 2024

Preprint

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Background Ischemic stroke ranks at the forefront of the global spectrum of causes of death. Internal carotid artery stenosis is one of the causes of ischemic stroke, and CAS is an important method to treat internal carotid artery stenosis. However, postoperative hypotension and other complications can lead to serious neurological defects. Methods The clinical data and imaging data of patients with internal carotid artery stenosis treated by stenting in the Department of Neurology of the Second Affiliated Hospital of Xinjiang Medical University from January 2021 to December 2023 were collected for statistical analysis. Results A total of 23 patients were enrolled, 87% were male, the median age of onset was 65 years (IQR, 57-71 years), 56.2% had a history of smoking, 82.6% had hypertension, 78.9% had poor blood pressure control, 47.8% had a chronic disease, 81.8% of whom were hypertensive. Before admission, 74% of the patients had transient or persistent neurological impairment, that is TIA or IS at any stage. Of the 46 internal carotid arteries in 23 patients, 25 (54.3%) had severe stenosis, 60.9% had bilateral stenosis, and 85.7% mainly had bi-focal or severe and moderate stenosis on one side. 60.9% developed postoperative hypotension, of which 57.1% were treated with vasoactive drugs. Only HDL levels were different in the three groups with normal blood pressure, rehydration after hypotension, and medication after hypotension. Conclusions HDL level does not predict whether blood pressure will decrease after surgery, but if carotid sinus response occurs, high HDL (≧1.0mmol/L) may be more likely to require vasopressor therapy while low HDL (<1.0mmol/L) can be treated with fluid rehydration.

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Section: Discussionmentioning

confidence: 99%

HDL can predict the treatment of hypotension after CAS surgery for initial internal carotid artery stenosis

Ma,

Yang,

et al. 2024

Preprint

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“… 14 Its use during routine CAS subsequently declined over time as there was paucity of clear benefit, particularly as the use of distal embolic protection became widespread. 15 , 16 More recently, eptifibatide has been employed as a “rescue” therapy in acute CAS or intracranial procedures, owing to its rapid onset and profound inhibitive effect on platelet aggregation. 17 Perhaps the most crucial advantage afforded to surgeons by eptifibatide is the ability to operate almost immediately after drug cessation; in the PURSUIT trial, CTS was proven safe within as little as two hours of eptifibatide cessation.…”

Section: Discussionmentioning

confidence: 99%

Eptifibatide bridging therapy for staged carotid artery stenting and cardiac surgery: Safety and feasibility

et al. 2022

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Background Prophylactic carotid artery stenting (CAS) is an effective strategy to reduce perioperative stroke in patients with severe carotid stenosis who require cardiothoracic surgery (CTS). Staging both procedures (CAS-CTS) during a single hospitalization presents conflicting demands for antiplatelet therapy and the optimal pharmacologic strategy between procedures is not established. The purpose of this study is to present our initial experience with a “bridging” protocol for staged CAS-CTS. Methods A retrospective review of staged CAS-CTS procedures at a single referral center was performed. All patients had multivessel coronary and/or valvular disease and severe carotid stenosis (>70%). Patients not previously on aspirin were also started on aspirin prior to surgery, followed by eptifibatide during CAS (intraprocedural bolus followed by post-procedural infusion which was continued until the morning of surgery). Pre- and perioperative (30 days) neurologic morbidity and mortality was the primary endpoint. Results 11 CAS procedures were performed in 10 patients using the protocol. The median duration of eptifibatide bridge therapy was 36 h (range 24–288 h). There was one minor bleeding complication (1/11, 9.1%) and no major bleeding complications during the bridging and post-operative period. There was one post-operative, non-neurologic death and zero perioperative ischemic strokes. Conclusions For patients undergoing staged CAS-CTS, Eptifibatide bridging therapy is a viable temporary antiplatelet strategy with a favorable safety profile. This strategy enables a flexible range of time-intervals between procedures.

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“…None of the 14 patients with acute stroke and treated with eptifibatide during CAS had ICH. There has been contradicting safety data regarding the use of GP IIb/IIIa inhibitors during CAS (Qureshi et al, 2002; Chan et al, 2005; Kramer et al, 2007; Zahn et al, 2007) however, most of these studies were focused on abciximab during CAS. Kapadia et al evaluated 151 patients with CAS, 128 of those had been prophylactically treated with abciximab while the rest of cohort was treated with intravenous heparin.…”

Section: Discussionmentioning

confidence: 99%

How Safe is Eptifibatide during Urgent Carotid Artery Stenting?

Allam¹,

Vora²,

Edgell³

et al. 2013

Front. Neur.

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Background: Glycoprotein IIB/IIIA inhibitors are occasionally utilized during carotid artery stenting (CAS) in the presence or absence of a visualized intra-operative thrombus.Objective: We assess the hemorrhagic and clinical outcomes associated with the use of eptifibatide during CAS.Methods: A retrospective analysis of prospectively collected data on patients with the diagnosis of carotid artery stenosis underwent CAS in a single center. We identified those who received intravenous eptifibatide intra-operatively and compared to the rest of the cohort. Hemorrhagic outcomes included intracerebral hemorrhage (ICH) or groin hematoma that occurred during the hospital stay.Results: In this analysis, 81 patients had CAS during a 3-year span; 16 of those had received 15 mg of intravenous eptifibatide intra-operatively. The mean age of the treated and untreated patients was similar (65.6 ± 13.4 versus 65.4 ± 10.2; P = 0.13). One patient (1.2%) in this series had ICH in the perioperative period that occurred in the non-eptifibatide group. Five patients (6.2%) in this series had groin hematoma; only one in the non-eptifibatide group required surgical repair. No mortality was reported and clinical outcomes including discharge modified Rankin scale, NIH stroke scale, as well as discharge destination were similar in both groups. A stratified analysis among those who underwent an urgent CAS showed no significant differences in the risks of hemorrhages or any clinical outcome (P > 0.05).Conclusion: The use of eptifibatide during CAS is safe. The risk of any hemorrhagic complication is rare in this series; however, a prospective study to validate this observation will be helpful.

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Glycoprotein IIb/IIIa antagonists during carotid artery stenting:

Cited by 21 publications

References 28 publications

HDL can predict the treatment of hypotension after CAS surgery for initial internal carotid artery stenosis

HDL can predict the treatment of hypotension after CAS surgery for initial internal carotid artery stenosis

Eptifibatide bridging therapy for staged carotid artery stenting and cardiac surgery: Safety and feasibility

How Safe is Eptifibatide during Urgent Carotid Artery Stenting?

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