Introduction Mechanical thrombectomy for large vessel occlusion can be complicated by undelrying intracranial atherosclerotic disease (ICAD), dissection or tandem occlusions predisposing to re-occlusion and poor outcomes. The terminology unstable vessel wall (UVW) has been used to describe these conditions mandating aggressive anti-platelet therapy (aAPT). Data on concurrent aAPT therapy with thrombectomy is lacking.

Aim of Study To evaluate the safety and efficacy of Eptifibatide (EPT) in thrombectomy complicated by UVW.

Methods This study analysed characteristics, procedural details and follow-up imaging of patients who received Eptifibatide between March 2022 and May 2023. Haemorrhage defined by ECASS criteria and patency of the index artery on follow-up imaging has been evaluated to assess the safety and efficacy of EPT respectively.

Results 16 consecutive patients (mean age: 57.0 ± 18.3 years, male n = 13) presenting with a mean NIHSS score of 11 received Eptifibatide during study period. 11 had thrombectomy complicated by ICAD while 5 had extracranial carotid stenting with one having both. In the ICAD group, 8 patients had repeat thrombectomy while 3 had intracranial angioplasty and one patient proceeding to intracranial stenting. TICI2b/3 recanalisation was achieved in all patients except one presenting with flow diverting stent occlusion. H12 haemorrhage occurred in 3 patients on early follow-up CT, but no HI1 or PH haemorrhage. Follow-up CTA confirmed vascular patency in all patients with successful TICI 2b/3 recanalisation.

Conclusion Eptifibatide was shown to be a safe and effective adjunct to mechanical thrombectomy complicated by UVW. Further studies are recommended.

Disclosure of Interest Presenting author has/had consultancy agreements with Stryker Neurovascular, Medtronic and Microvention Terumo and served as PI for SWIFT DIRECT study at St.George’s NHS Foundation Trust, London.