Background Coil embolization of intracranial aneurysms is being increasingly used; however, thromboembolic events have become a major periprocedural complication.
Objective To determine the safety and efficacy of prophylactic tirofiban in patients with ruptured intracranial aneurysms.
Methods Tirofiban was administered as an intravenous bolus (8.0 μg/kg over 3 min) followed by a maintenance infusion (0.10 μg/kg/min) before stent deployment or after completion of single coiling. Dual oral antiplatelet therapy (loading doses) was overlapped with half the tirofiban dose 2 h before cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded.
Results Tirofiban was prophylactically used in 221 patients, including 175 (79.19%) who underwent stent-assisted coiling and 46 (20.81%) who underwent single coiling, all in the setting of aneurysmal subarachnoid hemorrhage. Six (2.71%) cases of intracranial hemorrhage occurred, including four (1.81%) tirofiban-related cases and two (0.90%) antiplatelet therapy-related cases. There were two (0.90%) cases of fatal hemorrhage, one related to tirofiban and the other related to dual antiplatelet therapy. Thromboembolic events occurred in seven (3.17%) patients (6 stent-assisted embolization, 1 single coiling), of which one (0.45%) event occurred during stenting and six (2.72%) occurred during intravenous tirofiban maintenance. No thromboembolic events related to dual antiplatelet therapy were found.
Conclusions Tirofiban bolus over 3 min followed by maintenance infusion appears to be a safe and efficient prophylactic protocol for the endovascular treatment of ruptured intracranial aneurysms and may be an alternative to intraoperative oral antiplatelet therapy, especially in the case of stent-assisted embolization.
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Contributors X-dL, Z-lW, T-xL, W-xB and Y-yW: conception and design. Y-kH and W-xB: literature research. X-dL, G-yZ, Y-yW, Z-lW, T-xL and Y-kH: statistical analysis and drafting the manuscript. All authors were involved in acquisition of data, analysis and interpretation of data, critical revision of the manuscript and approval of the final manuscript.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Ethics approval was obtained from the institutional review board of our hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Unpublished data may be available to academic researchers on a per request basis to the corresponding author.
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