Lyophilizing thrombin powder-based treatment for hemostasis during coil embolization of ruptured cerebral aneurysm: Two case reports

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Rupture of cerebral aneurysm is an inevitable complication during embolization, followed by subsequent acute subarachnoid hemorrhage or intracranial hematoma, and results in the aggravation of a patient’s condition. In particular, for patients who have had a ruptured aneurysm, urgent treatment strategies are required during operation. The most common hemostatic methods seen in clinical practices are as follows: after lowering the blood pressure, we continue to embolize the aneurysms with detachable coils as soon as possible or inject with Glubran/Onyx embolization liquids, as well as use a balloon catheter to temporarily block the blood supply. If the conditions are permissible, a balloon guiding catheter may even be used to restrict the proximal blood flow. At times, due to limitations of these methods, neurosurgeons are requested to perform craniotomy to treat the hemostasis. However, the delayed transition often leads to rapid deterioration of the patient’s condition and even death due to cerebral hernia. </jats:p></jats:sec><jats:sec><jats:title>Case description</jats:title><jats:p> We herein presented two cases of ruptured cerebral aneurysms to provide an alternative method for hemostasis and to save the lives of patients as much as possible. In an extremely urgent situation (conventional treatment is ineffective), we successfully saved the patient’s life by injecting lyophilizing thrombin powder (LTP) solution into the aneurysmal sac and the parent artery through a microcatheter. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> To our knowledge, this is the first report of successful hemostasis during coil embolization of ruptured cerebral aneurysm with LTP. Further prospective studies are needed to confirm the safety and efficacy of LTP in cerebrovascular interventional therapy. </jats:p></jats:sec>

Topical lyophilized thrombin application improves wound healing for posterior spinal surgery

“…Lyophilization is preferred to maintain protein activity during drug development [ 32 ]. Previous case studies have used lyophilized thrombin powder to facilitate the treatments in patients with aneurysms [ 33 , 34 ]. In our study, we directly sprayed the lyophilized thrombin powder into the surgical wound, where it was dissolved in the exudate and converted into thrombin by the extrinsic activating pathway.…”

Successful treatment of iatrogenic internal carotid artery pseudoaneurysm following carotid endarterectomy with thrombin injection: a case report

“…In our previous reports, we detailed two cases of aneurysmal hemorrhage during aneurysm coiling, necessitating direct thrombin injection into the aneurysm cavity after failed therapeutic interventions. In both instances, prompt hemostasis was achieved with minimal adverse outcomes, and no distal embolic events occurred following thrombin injection [ 15 ]. Adhering to established clinical practice, a protective device was not utilized to prevent distal arterial embolism in the case of the carotid pseudoaneurysm.…”