Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Kim, Sanghyeon; Choi, Jae Hyuk; Kang, Min Kyung; Cha, Jae‐Kwan; Huh, Jae-Taeck

doi:10.3174/ajnr.a4551

Cited by 51 publications

(33 citation statements)

References 31 publications

(27 reference statements)

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“…Our results also showed a trend toward increased risk of thrombus formation during stent-assisted coiling, probably because of insufficient use of antiplatelet therapy in the early stage of subarachnoid hemorrhage or resistance to antiplatelet therapy 24. Kim et al 25 suggested that use of intravenous tirofiban may be an effective approach during stent-assisted coiling of ruptured aneurysms. However, intravenous tirofiban or abciximab before stent placement was not used in our patients because the safety of these drugs was unclear during our study.…”

Section: Discussionsupporting

confidence: 51%

Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms

Fan

Lin

et al. 2016

J NeuroIntervent Surg

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Section: Discussionsupporting

confidence: 51%

Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms

Fan

Lin

et al. 2016

J NeuroIntervent Surg

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“…Higher doses are required if a thrombotic stent occlusion has already occurred. Tirofiban has also been used for this purpose [ 16 ] and with similar results.…”

Section: Discussionmentioning

confidence: 99%

Stent placement in patients with acute subarachnoid haemorrhage: when is it justified?

et al. 2018

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PurposeEndovascular stents are widely used for the elective treatment of cerebral aneurysms. Acute stenting is performed in the management of dissections, pseudo-aneurysms, broad-based aneurysms or as a ‘bail out’ measure after coil migration. The purpose of this study is to review the safety of using stents in acute subarachnoid haemorrhage.MethodsThe stent registry of our institution was reviewed for procedures in patients with acute subarachnoid haemorrhage. Imaging studies were reviewed on the hospital’s PACS system and the patients’ notes were retrieved to assess complications and clinical outcomes. Procedures were analysed according to the type of stent, treatment indication, antiplatelet regime, complications and outcomes.ResultsBetween 2008 and 2016, 51 stents were placed during 50 stenting procedures in 49 patients with acute subarachnoid haemorrhage. This included 24 patients with saccular aneurysms, 10 with blister aneurysms, 10 dissections and five fusiform aneurysms. Stents were deployed in ‘bail out’ situations on eight occasions. In six cases, flow-diverting stents were used. Eighteen patients (37%) in the cohort suffered a stroke. Nine patients (18%) suffered persistent clinical deficits as a result of the stenting procedure, all but one of which occurred within 24 h. Two patients had a transient ischaemic episode, and there was evidence of asymptomatic ischaemia on imaging in four cases (8%). Five patients died, three (6%) as a result of procedural complications. Twelve patients (25%) required a further embolisation procedure.ConclusionThe use of stents in acute subarachnoid haemorrhage incurs a considerable complication risk and should be reserved for exceptional circumstances.

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“…Another small series reported on the use of tirofiban for SAC of acutely ruptured intracranial aneurysms. Kim et al treated 41 patients with SAC and intravenous tirofiban: 0.4 µg/kg/min bolus for 30 min, followed by 0.10 µg/kg/min maintenance infusion 26. Intravenous heparin was administered (5000 U/1000 mL of 0.9% normal saline) as a maintenance infusion through the guide catheter, but no bolus was infused.…”

Section: Discussionmentioning

confidence: 99%

Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms

et al. 2019

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BackgroundEndovascular treatment of intracranial aneurysms usually involves stent-assisted coiling (SAC) and flow diverters. Glycoprotein IIb/IIIa inhibitors such as tirofiban and dual antiplatelet therapy (DAPT) are required to prevent thromboembolic complications afterwards. We sought to determine the safety of tirofiban and DAPT in these cases.MethodsWe conducted a retrospective analysis of our database for patients with intracranial aneurysms who underwent SAC or flow diversion. The tirofiban-DAPT protocol used is described. Data regarding duration of infusion, placement of external ventricular devices (EVDs), complications, haemoglobin levels and platelet count before and 24 hours after antiplatelet therapy were collected and analysed.ResultsOne-hundred and forty-one patients with 148 aneurysms/procedures were included. 110 aneurysms were treated acutely and 38 electively. Minor and major haemorrhagic events were recognised in 20% (30/148) aneurysms. Only 5 (3.4%) intracerebral haemorrhages were symptomatic: 3 cortical/SAH and 2 EVD-related. The average blood volume in symptomatic haemorrhages was 24.8 cc versus 5.42 cc in asymptomatic haemorrhages (p=0.002). The rate of EVD-related haemorrhages was 15.7% (19/121) and only 2 (1.7%) were symptomatic. Most haemorrhagic events occurred in ruptured aneurysms (90.1%, p=0.01). No significant change in platelet count or haemoglobin levels before and 24 hours after administration of tirofiban and DAPT was documented. Concomitant administration of heparin did not increase haemorrhagic events.ConclusionThe use of the GP IIb/IIIa inhibitors tirofiban and DAPT in this series was safe. Tirofiban and DAPT did not affect platelet count or haemoglobin levels and did not increase rate of symptomatic haemorrhages or thromboembolic complications.

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Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Cited by 51 publications

References 31 publications

Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms

Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms

Stent placement in patients with acute subarachnoid haemorrhage: when is it justified?

Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms

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