Intra-arterial abciximab for the treatment of thrombus formation during coil embolization of intracranial aneurysms
Department of Radiology; Department of Neurological Surgery; Department of Neurology
Medical Subject Headings
Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured; Antibodies, Monoclonal; Embolization, Therapeutic; Female; Follow-Up Studies; Humans; Immunoglobulin Fab Fragments; Infusions, Intra-Arterial; Intracranial Aneurysm; Male; Middle Aged; Prospective Studies; Retrospective Studies; Thrombosis; Treatment Outcome
Life Sciences | Medicine and Health Sciences
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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Citation: J Neurointerv Surg. 2010 Jun;2(2):135-8. Link to article on publisher's site
Linfante, Italo; Etezadi, Vahid; Andreone, Vincenzo; DeLeo, Michael J. III; Alehashemi, Sara; Shaw, Kate; and Wakhloo, Ajay K., "Intra-arterial abciximab for the treatment of thrombus formation during coil embolization of intracranial aneurysms" (2010). University of Massachusetts Medical School. Senior Scholars Program. Paper 130.