Intra-Arterial Tirofiban Infusion for Thromboembolism During Endovascular Treatment of Intracranial Aneurysms

Kang, Hyun-Seung; Kwon, Bum Sun; Roh, Hong Gee; Yoon, Sung Won; Chang, Hyuk Won; Kim, Jeong Eun; Han, Moon Hee

doi:10.1227/01.neu.0000320440.85178.cc

Cited by 45 publications

(32 citation statements)

References 18 publications

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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%

“…[1][2][3][7][8][9][10]12 Aviv et al 3 reported 13 patients with ruptured aneurysm treated with abciximab rescue therapy and only 1 hemorrhagic complication. Aggour et al 2 included 11 patients with ruptured aneurysm in their abciximab rescue series without hemorrhagic complication.…”

Section: May 2013mentioning

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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Section: Discussionmentioning

confidence: 95%

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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“…In comparison, the collective experience with similar use of intra-arterial abciximab (IAA) or tirofiban shows an average rate of complete recanalization of 73.9 and 67.7%, respectively (table 5) [9,13,14,15,16,17,18,19,20,21,22,23,24]. More studies are warranted in further exploring the efficacy of IAE.…”

Section: Discussionmentioning

confidence: 99%

Intra-Arterial Eptifibatide in the Management of Thromboembolism during Endovascular Treatment of Intracranial Aneurysms: Case Series and a Review of the Literature

et al. 2013

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Objectives: Thromboembolic complications are well recognized during the endovascular management of intracranial aneurysms. In this study, we present a case series of 40 patients with intraprocedural thrombotic complications who were treated with intra-arterial eptifibatide (IAE), and a review of the literature. Methods: Twenty-five patients with ruptured intracranial aneurysms (RIA), 10 with unruptured intracranial aneurysms (UIA) and 5 with aneurysmal subarachnoid hemorrhage-induced vasospasm (VSP) received IAE for intraprocedural thrombi during endovascular treatment. Rates of recanalization, strokes, and hemorrhagic complications were assessed. Results: Recanalization was achieved in 96% (24/25) of the RIA patients [72% (18/25) complete; 24% (6/25) partial], in 100% (10/10) of the UIA patients [90% (9/10) complete; 10% (1/10) partial], and in 100% (5/5) of the VSP patients [80% (4/5) complete; 20% (1/5) partial]. Strokes following intraprocedural thrombosis were coil-related (20%, 5/25) or stent-related (12%, 3/25) in RIA patients, stent-related (10%, 1/10) in UIA patients, and heparin-induced thrombocytopenia type II-related (60%, 3/5) or vasospasm-related (20%, 1/5) in VSP patients. There were no intracerebral hemorrhagic complications in UIA. Intracerebral hemorrhage was observed in 20% of the RIA patients (5/25), all of whom had received intra-arterial thrombolytics and/or high-dose heparin infusion in addition to IAE; in 12%, this was external ventricular drain-related (3/25), 4% had parenchymal hematoma type 1 (1/25), and 4% parenchymal hematoma type 2 (1/25). One of the 5 VSP patients, who had received argatroban in addition to IAE, had parenchymal hematoma type 1. No clinically significant systemic hemorrhage was observed in this study. Conclusion: Treatment of thromboembolic complications with IAE during endovascular management of aneurysms was effective in achieving recanalization and overall well tolerated in this series.

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“…Three patients were rated Fisher I, 32 Fisher II, 16 Fisher III, and 49 Fisher IV (19 of whom had a cerebral hematoma).…”

Section: Methodsmentioning

confidence: 99%

Administration of eptifibatide during endovascular treatment of ruptured cerebral aneurysms reduces the rate of thromboembolic events

et al. 2014

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Intra-Arterial Tirofiban Infusion for Thromboembolism During Endovascular Treatment of Intracranial Aneurysms

Abstract: Intra-arterial tirofiban delivery appears to be a safe and effective treatment modality when thromboembolism is encountered during the endovascular treatment of intracranial aneurysms.

Cited by 45 publications

References 18 publications

Rescue Treatment of Thromboembolic Complications During Endovascular Treatment of Cerebral Aneurysms

Rescue Treatment of Thromboembolic Complications During Endovascular Treatment of Cerebral Aneurysms

Intra-Arterial Eptifibatide in the Management of Thromboembolism during Endovascular Treatment of Intracranial Aneurysms: Case Series and a Review of the Literature

Administration of eptifibatide during endovascular treatment of ruptured cerebral aneurysms reduces the rate of thromboembolic events

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