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Glycoprotein IIb/IIIa Inhibitor Bridging and Subsequent Endovascular Therapy in Vertebrobasilar Occlusion in 120 Patients

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Abstract

Purpose

The treatment mode in acute vertebrobasilar occlusion (VBO) remains uncertain. We analyzed efficacy and safety of intravenous glycoprotein IIb/IIIa inhibitor (IV GPI) plus subsequent intra-arterial thrombolysis with or without additional endovascular mechanical therapy (percutaneous transluminal angioplasty/stenting or thrombus aspiration) and sought treatment factors that predict good clinical outcome.

Methods

We retrospectively analyzed 120 cases of patients with angiographically proven acute VBO. Multivariate logistic regression was used to identify independent predictors for clinical outcome and included level of consciousness, age, sex, time to angiography, GPI agent, admission mode, occlusion type, recanalization success, and endovascular treatment mode. Clinical follow-up was dichotomized in no to moderate disability (modified Rankin scale (mRS) 0–3) vs. severe disability or death (mRS 4–6).

Results

Median National Institutes of Health stroke scale (NIHSS) score on admission was 32, and mean NIHSS score was 24. A total of 49 patients (41 %) developed no to moderate disability (mRS 0–3), and 39 patients (33 %) died. Thrombolysis in myocardial infarction 2/3 recanalization success was achieved in 97 patients (80.8 %). Symptomatic intracerebral hemorrhages occurred in 11 patients (9 %). Mild impairment of consciousness (p < 0.001) and embolic occlusion type (p = 0.01) were significant predictors of favorable outcome. Clinical outcome in recanalized patients was better, but not statistically significant (p = 0.055).

Conclusions

Our results indicate that combined therapy with IV GPI and subsequent endovascular therapy may be a valid treatment strategy in acute VBO. With this treatment approach, a preserved vigilance before treatment and an embolic occlusion type are associated with no to moderate disability.

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Abbreviations

VBO:

Vertebrobasilar occlusion

IV GPI:

Intravenous glycoprotein IIb/IIIa inhibitor

TIMI:

Thrombolysis in myocardial infarction

PTA:

Percutaneous transluminal angioplasty

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Acknowledgments

We acknowledge the efforts of Dr. Jan-Hendrik Buhk in kindly reviewing the manuscript and providing some very valuable suggestions enabling us to improve on the quality of the manuscript.

Sources of Funding

None.

Disclosures

J. Fiehler consults for Company Microvention, Stryker, Codman and is a speaker for Covidien.

Conflict of Interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Haus Ost 22 (O 22), Martinistr. 52, 20246, Hamburg, Germany

    M. Ernst MD & J. Fiehler MD

  2. Department of Neurology, Hospital Buchholz, Buchholz in der Nordheide, Germany

    F. Butscheid MD

  3. Radiological Office Buchholz, Buchholz in der Nordheide, Germany

    O. Wittkugel MD

  4. Department of Neuroradiology, Helios Klinik Schwerin, Schwerin, Germany

    K. Alfke MD

  5. Department of Neuroradiology, University Medical Center Kiel, Kiel, Germany

    O. Jansen MD

  6. Department of Neuroradiology, University Medical Center Luebeck, Luebeck, Germany

    D. Petersen MD & C. Koch MD

  7. Department of Neuroradiology, Asklepios Klinik Altona, Hamburg, Germany

    B. Eckert MD

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  1. M. Ernst MD
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  2. F. Butscheid MD
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  3. J. Fiehler MD
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  8. C. Koch MD
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Correspondence to M. Ernst MD.

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Ernst, M., Butscheid, F., Fiehler, J. et al. Glycoprotein IIb/IIIa Inhibitor Bridging and Subsequent Endovascular Therapy in Vertebrobasilar Occlusion in 120 Patients. Clin Neuroradiol 26, 169–175 (2016). https://doi.org/10.1007/s00062-014-0341-3

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  • DOI: https://doi.org/10.1007/s00062-014-0341-3

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