Abciximab Bolus Injection Does Not Reduce Cerebral Ischemic Complications of Elective Carotid Artery Stenting

Hofmann, Robert; Kerschner, Klaus; Steinwender, Clemens; Kypta, Alexander; Bibl, D.; Leisch, F

doi:10.1161/hs0302.104545

Cited by 47 publications

(15 citation statements)

References 22 publications

(9 reference statements)

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“…Two abciximab-treated patients developed fatal intracerebral hemorrhage. Hofmann et al 11 had similar observation in a randomized comparison between abciximab bolus prior to the procedure and standard antithrombotic treatment. The 37 patients who received abciximab experienced 4 TIAs, 1 minor stroke, 1 major stroke, and 1 fatal stroke (overall rate of 19%) compared to 8% (2 TIAs and 1 major stroke) in the 37 patients who received standard treatment.…”

mentioning

confidence: 72%

Adjunctive Use of Platelet Glycoprotein IIb/IIIa Inhibitors for Carotid Angioplasty and Stent Placement: Time to Say Good Bye?

Qureshi¹

2003

J Endovasc Ther

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Carotid angioplasty and stenting (CAS) is gaining popularity as an alternative method for treatment of carotid stenosis, particularly in high-risk surgical patients. A limitation of CAS is the periprocedural risk of temporary or permanent ischemic neurological deficits. In a review of 14 studies reporting upon 834 patients who underwent CAS, 1 73 (8.8%) patients experienced thromboembolic events: transient ischemic attacks (TIA) in 26 and ischemic stroke in 47. Most of these deficits resulted from local thrombosis and distal embolization. Platelet adhesion and aggregation following CAS occur as a result of damage to the vessel wall and local exposure of the subendothelium. 2 Platelets have specific membrane glycoproteins (GPs) that bind to exposed proteins in the subendothelial layers. 2 Platelet adhesion is followed by platelet activation, which causes morphological changes in the shape of platelets and activation of membrane GP IIb/IIIa receptors. These activated GP IIb/IIIa receptors bind to fibrinogen molecules, which subsequently form bridges between adjacent platelets to facilitate platelet aggregation and subsequent thrombus formation.A novel approach that has demonstrated great promise after extensive clinical evaluation in coronary interventions 3,4 involves the use of platelet inhibitors that block the platelet GP IIb/IIIa receptors. Unlike aspirin, this new class of drugs prevents the binding of fibrinogen to these receptors, thereby inhibiting platelet aggregation irrespective of the metabolic pathway responsible for the initiation of platelet aggregation. 2 Because of similarities between angioplasty and stent placement and subsequent vascular response in the coronary and carotid arteries, investigators have used GP IIb/IIIa inhibitors as adjunctive therapy during CAS. 5 Most reports of GP IIb/IIIa inhibition during CAS feature the use of abciximab, an antibody-immunoglobulin compound. Intravenously administered abciximab is a short-acting agent with a half-life of 10 minutes, but its effect on platelets last for almost 48 hours. 2 Another compound, eptifibatide, a cyclic peptide that may be a more specific inhibitor of GP IIb/IIIa receptors, has recently undergone preliminary clinical evaluation for CAS. 6 Experience with nonpeptide inhibitors of GP IIb/ IIIa receptors, i.e., lamifiban and tirofiban, is very limited.The majority of studies on GP IIb/IIIa inhibition during CAS involve nonrandomized series of patients treated with intravenous abciximab. 7 Kapadia et al. 8 reported upon 128 patients who were administered intravenous abciximab (bolus followed by infusion) during and immediately after CAS. The ischemic event rate was significantly lower in the abciximab-treated group compared with 23 historical controls (1.6% versus 8%). The only major stroke was observed in the control group. In another prospective observational study, 9 37 high-risk patients were treated with intravenous abciximab (bolus followed by infusion); another 33 low-risk patients not re-

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mentioning

confidence: 72%

Adjunctive Use of Platelet Glycoprotein IIb/IIIa Inhibitors for Carotid Angioplasty and Stent Placement: Time to Say Good Bye?

Qureshi¹

2003

J Endovasc Ther

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“…However, this was not confirmed in a randomized, controlled trial. 25 The incidence of TIA or strokes was not significantly different with the use of abciximab in addition to standard antithrombotic therapy. Another study in fact found a higher incidence of intracerebral hemorrhages in patients who had recent cerebral ischemic events.…”

Section: Measures To Reduce Complications With Stentingmentioning

confidence: 90%

Nonsurgical Carotid Revascularization

Mathew

Bhatia

Francis

2005

Cardiology in Review

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Carotid endarterectomy is a well-established treatment of improving the carotid luminal diameter and preventing strokes, and the indications and complications are well-defined. Carotid angioplasty and stent placements are relatively newer ways of treating carotid artery stenosis. In certain contexts, they may have some advantages over carotid endarterectomy. However, the success rates, morbidity, and mortality associated with these procedures are less well characterized. In earlier comparative studies, the incidence of ipsilateral stroke rate was higher with angioplasty, but in later studies, this trend is reversing. Angioplasty may also have an edge in specific situations like patients with coexisting significant coronary arterial disease, contralateral carotid artery occlusion, and in instances when the narrowing is long and at multiple sites. Protective devices like distal occlusion balloon and filter protection devices may reduce the incidence of stroke. We are still awaiting the results of some major randomized head-to-head trials comparing carotid endarterectomy and stenting.

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“…18 The routine use in carotid artery stent placement was discontinued after a randomized trial, and 2 single-center comparisons with historical controls did not demonstrate any reduction in periprocedural ischemic events. [19][20][21] The relatively high rate of fatal intracerebral hemorrhages (ICHs) observed in studies also reduced the enthusiasm for using these agents. 22 Some local institutional review boards may require that planned use of these agents involve informing patients or relatives regarding such complications.…”

Section: Platelet Glycoprotein Iib/iiia Inhibitorsmentioning

confidence: 99%

Off-Label Use of Drugs and Devices in the Neuroendovascular Suite

Abdihalim

Hassan

Qureshi

2013

AJNR Am J Neuroradiol

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SUMMARY:The off-label use of drugs and devices in neuroendovascular procedures is common. Neurointerventionalists should be well aware of the level of evidence available in support of the off-label use of drugs and devices in their practice and some of the potential adverse events associated with them. These uses are categorized as I or II if they have been evaluated as primary or ancillary interventions in prospective trials/registries of neuroendovascular procedures and III if they were evaluated in case series. Category IV use is based on evaluation as primary or ancillary interventions in prospective trials/registries of non-neuroendovascular procedures. Physicians are allowed to use off-label drugs and procedures if there is strong evidence that they are beneficial for the patient. The neurointerventional professional societies agree that off-label use of drugs and devices is an important part of the specialty, but practicing providers should base their decisions on sound evidence when using such drugs and devices.ABBREVIATIONS: GDC ϭ Guglielmi detachable coil; IA ϭ intra-arterial; ICH ϭ intracerebral hemorrhage; PROACT ϭ Prolyse in Acute Cerebral Thromboembolism;

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Abciximab Bolus Injection Does Not Reduce Cerebral Ischemic Complications of Elective Carotid Artery Stenting

Cited by 47 publications

References 22 publications

Adjunctive Use of Platelet Glycoprotein IIb/IIIa Inhibitors for Carotid Angioplasty and Stent Placement: Time to Say Good Bye?

Adjunctive Use of Platelet Glycoprotein IIb/IIIa Inhibitors for Carotid Angioplasty and Stent Placement: Time to Say Good Bye?

Nonsurgical Carotid Revascularization

Off-Label Use of Drugs and Devices in the Neuroendovascular Suite

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