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Is eptifibatide a safe and effective rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization? Single-center experience in 42 cases and review of the literature

  • Interventional Neuroradiology
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Abstract

Introduction

Thromboembolic complications are the most frequent perioperative complications of endovascular treatment of intracranial aneurysms. Even if the effectiveness of glycoprotein IIb/IIIa inhibitors has been reported, the outcomes in published clinic data are contradictory. This study aims to assess the effectiveness and the safety of eptifibatide in thromboembolic complications during intracranial aneurysm embolization procedure.

Methods

Between 2006 and 2012, 650 patients with intracranial aneurysm were treated using endovascular coil embolization, and in 62 cases (9.5 %), an intra-arterial thrombus developed. Glycoprotein IIb/IIIa inhibitor was administrated in 45 of them who required a rescue treatment. These 45 patients were treated with an intra-arterial bolus (0.2 mg/kg) of eptifibatide. We respectively reviewed the angiographic and clinical outcomes, and the periprocedural complications of the rescue treatment.

Results

No intra- or early postoperative (48 h) bleeding was observed after treatment. A total recovery of the entire arterial tree (TICI 3) was established in 28 cases (62.2 %), a partial revascularization in 13 cases (28.8 %) (5 TICI 2A and 8 TICI 2B), and no revascularization or reperfusion (TICI 0 or TICI 1) in 4 cases (9 %). Eptifibatide was more effective on proximal obstructions and in-stent occlusions than on peripheral distal thrombus, which were completely disintegrated one time out of three.

Conclusion

Intra-operative intra-arterial use of eptifibatide does not imply an increase of hemorrhagic events. Even if eptifibatide allows for a high rate of arterial recanalization, its effectiveness seems to be less important in cases of distal occlusions.

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References

  1. Wallace RC, Furlan AJ, Moliterno DJ et al (1997) Basilar artery rethrombosis: successful treatment with platelet glycoprotein IIB/IIIA receptor inhibitor. AJNR Am J Neuroradiol 18:1257–1260

    CAS  PubMed  Google Scholar 

  2. Aviv RI, O'Neill R, Patel MC et al (2005) Abciximab in patients with ruptured intracranial aneurysms. AJNR Am J Neuroradiol 26:1744–1750

    PubMed  Google Scholar 

  3. Gralla J, Rennie AT, Corkill RA et al (2008) Abciximab for thrombolysis during intracranial aneurysm coiling. Neuroradiology 50:1041–1047

    Article  PubMed  Google Scholar 

  4. Ries T, Siemonsen S, Grzyska U et al (2009) Abciximab is a safe rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization: single center experience in 42 cases and review of the literature. Stroke 40:1750–1757

    Article  CAS  PubMed  Google Scholar 

  5. Park JH, Kim JE, Sheen SH et al (2008) Intraarterial abciximab for treatment of thromboembolism during coil embolization of intracranial aneurysms: outcome and fatal hemorrhagic complications. J Neurosurg 108:450–457

    Article  PubMed  Google Scholar 

  6. Qureshi A, Saad M, Zaidat OO et al (2002) Intracerebral hemorrhages associated with neurointerventional procedures using a combination of antithrombotic agents including abciximab. Stroke 33:1916–1919

    Article  CAS  PubMed  Google Scholar 

  7. Walsh RD, Barrett KM, Aguilar MI et al (2011) Intracranial hemorrhage following neuroendovascular procedures with abciximab is associated with high mortality: a multicenter series. Neurocrit Care 15:85–95

    Article  CAS  PubMed  Google Scholar 

  8. Kang HS, Kwon BJ, Roh HG et al (2008) Intra-arterial tirofiban infusion for thromboembolism during endovascular treatment of intracranial aneurysms. Neurosurgery 63:230–238

    Article  PubMed  Google Scholar 

  9. Higashida RT, Furlan AJ, Roberts H (2003) Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34:109–137

    Article  Google Scholar 

  10. Matsumoto Y, Kondo R, Matsumori Y et al (2012) Antiplatelet therapy for prevention of thromboembolic complications associated with coil embolization of unruptured cerebral aneurysms. Drugs R D 12:1–7

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. van Rooij WJ, Sluzewski M, Beute GN et al (2006) Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol 27:1498–1501

    PubMed  Google Scholar 

  12. Murayama Y, Nien YL, Duckwiler G et al (2003) Detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 98:959–966

    Article  PubMed  Google Scholar 

  13. Pelz DM, Lownie SP, Fox AJ (1998) Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 19:1541–1547

    CAS  PubMed  Google Scholar 

  14. Henkes H, Fischer S, Weber W et al (2004) Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 54:268–285

    Article  PubMed  Google Scholar 

  15. Grunwald IQ, Papanagiotou P, Politi M et al (2006) Endovascular treatment of unruptured intracranial aneurysms: occurrence of thromboembolic events. Neurosurgery 58:612–618

    Article  PubMed  Google Scholar 

  16. Oxley TJ, Dowling RJ, Mitchell PJ et al (2011) Antiplatelet resistance and thromboembolic complications in neurointerventional procedures. Front Neurol 83:1–9

    Google Scholar 

  17. Workman MJ, Cloft HJ, Tong FC et al (2002) Thrombus formation at the neck of cerebral aneurysms during treatment with Guglielmi detachable coils. AJNR Am J Neuroradiol 23:1568–1576

    PubMed  Google Scholar 

  18. Soeda A, Sakai N, Sakai H et al (2003) Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol 24:127–132

    PubMed  Google Scholar 

  19. Dion JE, Gates PC, Fox AJ et al (1987) Clinical events following neuroangiography: a prospective study. Stroke 18:997–1004

    Article  CAS  PubMed  Google Scholar 

  20. Earnest F IV, Forbes G, Sandok BA et al (1984) Complications of cerebral angiography: prospective assessment of risk. AJR Am J Roentgenol 142:247–253

    Article  PubMed  Google Scholar 

  21. Sedat J, Dib M, Lonjon M et al (2002) Endovascular treatment of ruptured intracranial aneurysms in patients aged 65 years and older: follow-up of 52 patients after one year. Stroke 33:2620–2625

    Article  CAS  PubMed  Google Scholar 

  22. Pierot L, Cognard C, Anxionnat R et al (2010) Ruptured intracranial aneurysms: factors affecting the rate and outcome of endovascular treatment complications in a series of 782 patients (CLARITY study). Radiology 256:916–923

    Article  PubMed  Google Scholar 

  23. Vermeulen M, van Vliet HH, Lindsay KW et al (1985) Source of fibrin/fibrinogen degradation products in the CSF after subarachnoid hemorrhage. J Neurosurg 63:573–577

    Article  CAS  PubMed  Google Scholar 

  24. Kasuya H, Shimizu T, Okada T et al (1988) Activation of the coagulation system in the subarachnoid space after subarachnoid hemorrhage: serial measurement of fibrinopeptide A and bradykinin of cerebrospinal fluid and plasma in patients with subarachnoid hemorrhage. Acta Neurochir (Wien) 91:120–125

    Article  CAS  Google Scholar 

  25. Ikeda K, Asakura H, Futami K et al (1997) Coagulative and fibrinolytic activation in cerebrospinal fluid and plasma after subarachnoid hemorrhage. Neurosurgery 41:344–350

    Article  CAS  PubMed  Google Scholar 

  26. Vinuela F, Duckwiler G, Mawad M (1997) Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482

    Article  CAS  PubMed  Google Scholar 

  27. Katsaridis V, Papagiannaki C, Violaris C (2006) Guglielmi detachable coil versus matrix coils: a comparison of the immediate posttreatment results of the embolisation of 364 aneurysms in 307 patients: a single-center, single-surgeon experience. AJNR Am J Neuroradiol 27:1841–1848

    CAS  PubMed  Google Scholar 

  28. Fiorella D, Albuquerque FC, Han P et al (2004) Strategies for the management of intraprocedural thromboembolic complications with abciximab (ReoPro). Neurosurgery 54:1089–1098

    Article  PubMed  Google Scholar 

  29. Park HK, Horowitz M, Jungreis C et al (2005) Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26:506–514

    PubMed  Google Scholar 

  30. Oishi H, Yamamoto M, Shimizu T et al (2012) Endovascular therapy of 500 small asymptomatic unruptured intracranial aneurysms. AJNR Am J Neuroradiol 33:958–964

    Article  CAS  PubMed  Google Scholar 

  31. Orrù E, Roccatagliata L, Cester G et al (2013) Complications of endovascular treatment of cerebral aneurysms. Eur J Radiol 82:1653–1658

    Article  PubMed  Google Scholar 

  32. Cronquist M, Pierrot L, Boulin A et al (1998) Local intraarterial fibrinolysis of thromboemboli occurring during endovascular treatment of intracranial aneurysm: a comparison of anatomic results and clinical outcome. AJNR AmJ Neuroradiol 19:157–165

    Google Scholar 

  33. Brinjikji W, McDonald JS, Kallmes DF et al (2013) Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms. Stroke 44:1343–1347

    Article  CAS  PubMed  Google Scholar 

  34. Coller BS (1997) GPIIb/IIIa antagonists: pathophysiologic and therapeutic insights from studies of c7E3 Fab. Thromb Haemost 78:730–735

    CAS  PubMed  Google Scholar 

  35. Bendok BR, Padalino DJ, Levy EI et al (2004) Intravenous abciximab for parent vessel thrombus during basilar apex aneurysm coil embolization: case report and literature review. Surg Neurol 62:304–311

    Article  PubMed  Google Scholar 

  36. Alexander MJ, Duckwiler GR, Gobin YP et al (2002) Management of intraprocedural arterial thrombus in cerebral aneurysm embolization with abciximab: technical case report. Neurosurgery 50:899–902

    Article  PubMed  Google Scholar 

  37. Aggour M, Pierot L, Kadziolka K et al (2010) Abciximab treatment modalities for thromboembolic events related to aneurysm coiling. Neurosurgery 67:503–508

    Article  PubMed  Google Scholar 

  38. Song JK, Niimi Y, Fernandez PM et al (2004) Thrombus formation during intracranial aneurysm coil placement: treatment with intra-arterial abciximab. AJNR Am J Neuroradiol 25:1147–1153

    PubMed  Google Scholar 

  39. Velat GJ, Burry MV, Eskioglu E et al (2006) The use of abciximab in the treatment of acute cerebral thromboembolic events during neuroendovascular procedures. Surg Neurol 65:352–359

    Article  PubMed  Google Scholar 

  40. Jones RG, Davagnanam I, Colley S et al (2008) Abciximab for treatment of thromboembolic complications during endovascular coiling of intracranial aneurysms. AJNR Am J Neuroradiol 29:1925–1929

    Article  CAS  PubMed  Google Scholar 

  41. Mounayer C, Piotin M, Baldi S et al (2003) Intraarterial administration of abciximab for thromboembolic events occurring during aneurysm coil placement. AJNR Am J Neuroradiol 24:2039–2043

    PubMed  Google Scholar 

  42. Duncan IC, Fourie PA (2002) Catheter-directed intra-arterial abciximab administration for acute thrombotic occlusions during neurointerventional procedures. Interv Neuroradiol 8:159–168

    CAS  PubMed Central  PubMed  Google Scholar 

  43. Linfante I, Etezadi V, Andreone V et al (2010) Intra-arterial abciximab for the treatment of thrombus formation during coil embolization of intracranial aneurysms. J Neurointerv Surg 2:135–138

    Article  PubMed  Google Scholar 

  44. Ng PP, Phatouros CC, Khangure MS (2001) Use of glycoprotein IIb-IIIa inhibitor for a thromboembolic complication during Guglielmi detachable coil treatment of an acutely ruptured aneurysm. AJNR Am J Neuroradiol 22:1761–1763

    CAS  PubMed  Google Scholar 

  45. Cloft HJ, Samuels OB, Tong FC et al (2001) Use of abciximab for mediation of thromboembolic complications of endovascular therapy. AJNR Am J Neuroradiol 22:1764–1767

    CAS  PubMed  Google Scholar 

  46. Katsaridis V, Papagiannaki C, Skoulios N et al (2008) Local intra-arterial eptifibatide for intraoperative vessel thrombosis during aneurysm coiling. AJNR Am J Neuroradiol 29:1414–1417

    Article  CAS  PubMed  Google Scholar 

  47. Li YF, Spencer FA, Becker RC (2002) Comparative efficacy of fibrinogen and platelet supplementation on the in vitro reversibility of competitive glycoprotein IIb/IIIa receptor-directed platelet inhibition. Am Heart J 143:725–732

    Article  CAS  PubMed  Google Scholar 

  48. Dumont TM, Kan P, Snyder KV et al (2012) Adjunctive use of eptifibatide for complication management during elective neuroendovascular procedures. J Neurointerv Surg 12:36–43

    Google Scholar 

  49. Yi HJ, Gupta R, Jovin TG et al (2006) Initial experience with the use of intravenous eptifibatide bolus during endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 27:1856–1860

    CAS  PubMed  Google Scholar 

  50. Bruening R, Mueller-Schunk S, Morhard D et al (2006) Intraprocedural thrombus formation during coil placement in ruptured intracranial aneurysms: treatment with systemic application of the glycoprotein IIb/IIIa antagonist tirofiban. AJNR Am J Neuroradiol 27:1326–1331

    CAS  PubMed  Google Scholar 

  51. Jeon JS, Sheen SH, Hwang G et al (2012) Intraarterial tirofiban thrombolysis for thromboembolisms during coil embolization for ruptured intracranial aneurysms. J Cerebrovasc Endovasc Neurosurg 14:5–10

    Article  PubMed Central  PubMed  Google Scholar 

  52. Cho YD, Lee JY, Seo JH et al (2012) Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms. Eur J Radiol 81:2833–2838

    Article  PubMed  Google Scholar 

  53. Chalouhi N, Jabbour P, Kung D et al (2012) Safety and efficacy of tirofiban in stent-assisted coil embolization of intracranial aneurysms. Neurosurgery 71:710–714

    Article  PubMed  Google Scholar 

  54. Ciccone A, Valvassori L, Nichelatti M, The SYNTHESIS Expansion Investigators et al (2013) Endovascular treatment for acute ischemic stroke. N Engl J Med 10:904–913

    Article  Google Scholar 

  55. Adams HP Jr, Effron MB, Torner J et al (2008) Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: abciximab in emergency treatment of stroke trial (AbESTT-II). Stroke 39:87–99

    Article  CAS  PubMed  Google Scholar 

  56. The EPIC Investigators (1994) Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty. N Engl J Med 330:956–961

    Article  Google Scholar 

  57. The CAPTURE Investigators (1997) Randomised placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE study. Lancet 349:1429–1435

    Article  Google Scholar 

  58. Qureshi AI, Suri MF, Khan J et al (2000) Abciximab as an adjunct to high-risk carotid or vertebrobasilar angioplasty: preliminary experience. Neurosurgery 46:1316–1325

    Article  CAS  PubMed  Google Scholar 

  59. Hillegass WB, Newman AR, Raco DL (1999) Economic issues in glycoprotein IIb/IIIa receptor therapy. Am Heart J 138:24–32

    Article  Google Scholar 

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Authors and Affiliations

  1. Unité de Neurointerventionnelle, Hôpital Saint-Roch, 5 rue Pierre Devoluy, Nice, 06000, France

    Jacques Sedat, Yves Chau, Lydiane Mondot, Richard Chemla, Michel Lonjon & Bernard Padovani

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  1. Jacques Sedat
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  2. Yves Chau
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  3. Lydiane Mondot
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  4. Richard Chemla
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  5. Michel Lonjon
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Correspondence to Jacques Sedat.

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Sedat, J., Chau, Y., Mondot, L. et al. Is eptifibatide a safe and effective rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization? Single-center experience in 42 cases and review of the literature. Neuroradiology 56, 145–153 (2014). https://doi.org/10.1007/s00234-013-1301-3

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