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Intra-arterial abciximab for the treatment of thrombus formation during coil embolization of intracranial aneurysms
  1. Italo Linfante1,
  2. Vahid Etezadi1,
  3. Vincenzo Andreone2,
  4. Michael DeLeo2,
  5. Sara Alehashemi1,
  6. Kate Shaw2,
  7. Ajay Wakhloo2
  1. 1Baptist Cardiac and Vascular Institute, Miami, Florida, USA
  2. 2Section of Neuroimaging and Intervention, Departments of Radiology, Neurological Surgery, and Neurology. University of Massachusetts, Massachusetts, USA
  1. Correspondence to Italo Lifante, Baptist Cardiac and Vascular Institute, 8900 N Kendall Drive, Miami, FL 33176, USA; ItaloL{at}baptisthealth.net

Abstract

Background and purpose Thrombus formation during endovascular embolization of intracranial aneurysms occurs in 2.9%–6% of patients. Use of IIb/IIIA inhibitors such as abciximab or eptifibatide intravenously has been reported in management of this complication. Because the intra-arterial infusion of IIb/IIIA inhibitors may require lower doses to achieve thrombolysis, it may reduce the risk of haemorrhage. Therefore, we retrospectively analyze our database and review the literature.

Methods This is a retrospective analysis of a prospectively acquired database of patients with ruptured or unruptured aneurysm treated intra-arterially for thrombus formation during endovascular coil embolization between July 2005 and August 2008. Patient demographics, aneurysmal characteristics, procedural, clinical outcome and complications were recorded.

Results From July 2005 to August 2008, out of 184 patients who underwent coil embolization, 19 patients (15 smokers, 14 female, mean age 52) developed intraprocedural thrombus formation and received intra-arterial abciximab treatment. Mean aneurysm size was 6.6 mm±4.9 mm; neck size was 3.8 mm±2.1 mm. Eight (42.1%) aneurysms were ruptured. Most aneurysms (63.1%) were in anterior communicating and middle cerebral arteries. Thrombus was visualized in all cases by angiogram and treated intra-arterially with a mean dose of 10.5 mg±4.2. There were no periprocedural hemorrhagic complications. No deaths or other complications occurred during follow-up.

Conclusion Thrombus formation during coil embolization of intracranial aneurysms occurred more in women and smokers. Low doses of intra-arterial abciximab may be effective in the thromboembolic complications occurring during endovascular embolization of intracranial aneurysms.

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the institutional review board.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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