Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms

Liang, Xiaodong; Wang, Ziliang; Li, Tianxiao; He, Yingkun; Bai, Weixing; Wang, Yangyang; Zhou, Guoyu

doi:10.1136/neurintsurg-2015-012055

Cited by 39 publications

(28 citation statements)

References 25 publications

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“…In this way, tirofiban can be used as a rescue therapy for AIST. Numerous case reports, case series, retrospective reviews, and meta-analysis have evaluated the safety and efficacy of tirofiban in the treatment of acute thromboembolic complications during stent-assisted coil placement in intracranial aneurysms, with inspiring results (17)(18)(19)(20). Additionally, rescue use of tirofiban for acute carotid in-stent thrombosis has been reported for many years with satisfying outcomes (21).…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Tirofiban in Rescue Treatment for Acute Intracranial Intraprocedural Stent Thrombosis

et al. 2020

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Background and Purpose: The incidence of acute intraprocedural stent thrombosis (AIST) during stenting of intracranial atherosclerotic stenosis (ICAS) has seldom been reported and evidence regarding the treatment of AIST is lacking. We aim to investigate the incidence of AIST during stenting of ICAS in our institute, assess the preliminary efficacy and safety of rescue treatment of tirofiban for these patients. Methods: From September 2016 to May 2019, all symptomatic ICAS patients who underwent intracranial stenting in our institute were prospectively registered into this study, of which patients with AIST were retrospectively reviewed to extract baseline characteristics, perioperative management, procedural details, angiographic, and clinical outcomes. Rescue treatment of tirofiban for AIST was assessed by recanalization of the culprit vessel and periprocedural death, hemorrhage, and ischemic stroke. Results: Acute intraprocedural stent thrombosis developed in 12 (6.2%) patients within 30 min after stent placement of 194 patients. All 12 cases were successfully recanalized with modified Treatment in Cerebral Ischemia (mTICI) 3 and Arterial Occlusive Lesion (AOL) 3 after rescue treatment of tirofiban alone. There was no perioperative death or any hemorrhagic complication. Three patients suffered perioperative ischemic stroke. Conclusions: We observed a non-negligible rate of AIST during intracranial stenting procedures for ICAS. Intra-arterial bolus followed by intravenous tirofiban infusion seems to be efficacious and safe for AIST during stent placement for ICAS, without increasing the rate of hemorrhagic complications and death.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Tirofiban in Rescue Treatment for Acute Intracranial Intraprocedural Stent Thrombosis

et al. 2020

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“…Glycoprotein IIb/IIIa inhibitors have also been used systemically to prevent thromboembolic events. 12) 19) 28) Bruening et al 5) describe intravenous or intra-arterial injection of glycoprotein IIb/IIIa inhibitors upon the occurrence of thromboembolic events such as in-stent thrombosis or defective parent artery filling. However, as far as are aware, the present study was the first to examine tirofiban administration in SAC without pre- or intra-procedural aspirin, clopidogrel, or systemic heparinization.…”

Section: Discussionmentioning

confidence: 99%

“…However, as far as are aware, the present study was the first to examine tirofiban administration in SAC without pre- or intra-procedural aspirin, clopidogrel, or systemic heparinization. Although Liang et al 19) reported on the safety and efficacy of tirofiban administration in coil embolization of ruptured aneurysms, they included single coiling without stent deployment. The present study examines only coil embolization with stent deployment.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies 2) 3) 4) 5) 12) 14) 18) 20) 27) 28) have examined the use of aspirin, clopidogrel, heparin, or glycoprotein IIb/IIIa inhibitors as peri-procedural medications. However, to the best of our knowledge, there are no studies of glycoprotein IIb/IIIa inhibitor administration alone as a prophylactic for thromboembolic events following the SAC of ruptured aneurysm (in the three known studies 12) 19) 28) where a glycoprotein IIb/IIIa inhibitor has been used, heparin was also used). There are, however, several randomized controlled trials 10) 11) 13) 26) 30) that have evaluated glycoprotein IIb/IIIa inhibitor use in ischemic disease (e.g., cerebral infarction and myocardial infarction).…”

Section: Introductionmentioning

confidence: 99%

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Stent-Assisted Coil Embolization Using Only a Glycoprotein IIb/IIIa Inhibitor (Tirofiban) for Ruptured Wide-Necked Aneurysm Repair

Lee

Park

Lee

et al. 2018

J Cerebrovasc Endovasc Neurosurg

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ObjectiveThe aim of this study was to evaluate the safety and efficacy of stent-assisted coil embolization using only a glycoprotein IIb/IIIa inhibitor (tirofiban).Materials and MethodsWe retrospectively reviewed patients with a subarachnoid hemorrhage due to ruptured wide-necked intracranial aneurysms who were treated by stent-assisted coil embolization. In all patients, the glycoprotein IIb/IIIa inhibitor tirofiban was administered just before stent deployment. Electronic medical records for these patients were reviewed for peri-procedural complications and extra-ventricular drainage catheter related hemorrhage, as well as Glasgow outcome scale (GOS) at discharge, 3 months, and 6 months follow-up were recorded.ResultsFifty-one aneurysms in 50 patients were treated. The mean patient age was 64.9 years. Eighteen patients (36%) received a World Federation of Neurosurgical Societies grade of 4 or 5. The mean aneurysm size was 9.48 mm and mean dome-to-neck ratio was 1.06. No intraoperative aneurysm ruptures occurred, although five (10%) episodes of asymptomatic stent thrombosis did occur. Three patients experienced a delayed thrombo-embolic event and two a delayed hemorrhagic event. Immediate radiologic assessment indicated a complete occlusion in 29 patients, a residual neck in 19, and a residual sac in 3. Four patients (8%) died. Sixteen patients (32%) experienced a poor GOS (< 4). Two aneurysms were recanalized during the follow-up period (mean, 19 months for clinical and 18 months for angiographic follow-up).ConclusionTreatment of ruptured wide-necked intracranial aneurysms via stent-assisted coil embolization with a glycoprotein IIb/IIIa inhibitor alone was found to be relatively safe and efficient.

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“…Some studies suggested that the intraoperative use of tirofiban followed by the oral administration of two agents after surgery is the best method to reduce the risk of hemorrhagic/ischemic complications. 9,10) If this agent is approved in Japan in the future, it may reduce the incidence of complications related to SAC in the acute phase of ruptured cerebral aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Stent-assisted Coiling of Acutely Ruptured Cerebral Aneurysms

Nishimura

Ishibashi

Aoki

et al. 2018

JNET

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Purpose:The usefulness of stent-assisted coiling (SAC) of ruptured cerebral aneurysms has been reported, but a consensus has not been reached. We review the merits and limitations of this procedure based on our series. Subjects and Methods:Out of 96 ruptured cerebral aneurysms treated by endovascular treatment between July 2010and July 2016, five (5%) had SAC. We investigated this group's clinical characteristics, postoperative complications, and modified Rankin Scale (mRS) score after 6 months. Results:In all five patients, it was possible to insert a stent without difficulties, and there were no procedure-related complications. Diffusion-weighted brain MR images showed high-signal-intensity "spot-like" areas in all patients, remaining as asymptomatic cerebral infarctions and all stents remained completely patent. A hemorrhagic complication was observed in one patient who underwent later ventricle drainage. The mRS scores after 6 months were 0 in one patient, 1 in one patient, 3 in one patient, 4 in one patient, and 6 in one patient.Conclusion: SAC of ruptured cerebral aneurysms could be considered a useful treatment option although indicated for a limited number of patients with adequate use of antiplatelet treatment and cerebral spinal fluid (CSF) drainage for the subarachnoid hemorrhage (SAH).

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Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms

Cited by 39 publications

References 25 publications

Safety and Efficacy of Tirofiban in Rescue Treatment for Acute Intracranial Intraprocedural Stent Thrombosis

Safety and Efficacy of Tirofiban in Rescue Treatment for Acute Intracranial Intraprocedural Stent Thrombosis

Stent-Assisted Coil Embolization Using Only a Glycoprotein IIb/IIIa Inhibitor (Tirofiban) for Ruptured Wide-Necked Aneurysm Repair

Stent-assisted Coiling of Acutely Ruptured Cerebral Aneurysms

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