Abciximab for thrombolysis during intracranial aneurysm coiling
Thrombotic events are a common and severe complication of endovascular aneurysm treatment with significant impact on patients’ outcome. This study evaluates risk factors for thrombus formation and assesses the efficacy and safety of abciximab for clot dissolution.
Materials and methods
All patients treated with abciximab during (41 patients) or shortly after (22 patients) intracranial aneurysm coil embolisation were retrieved from the institutional database (2000 to 2007, 1,250 patients). Sixty-three patients (mean age, 55.3 years, ±12.8) had received either intra-arterial or intravenous abciximab. Risk factors for clot formation were assessed and the angiographic and clinical outcome evaluated.
No aneurysm rupture occurred during or after abciximab application. The intra-procedural rate of total recanalisation was 68.3%. Thromboembolic complications were frequently found in aneurysms of the Acom complex and of the basilar artery, whilst internal carotid artery aneurysms were underrepresented. Two patients died of treatment-related intracranial haemorrhages into preexisting cerebral infarcts. Two patients developed a symptomatic groin haematoma.
Abciximab is efficacious and safe for thrombolysis during and after endovascular intracranial aneurysm treatment in the absence of preexisting ischaemic stroke.
KeywordsAbciximab Aneurysm Endovascular treatment Thromboembolic complication
Conflict of interest statement
We declare that we have no conflict of interest.
- 11.Bruening R, Mueller-Schunk S, Morhard D, Seelos KC, Brueckmann H, Schmid-Elsaesser R 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(6):1326–1331PubMedGoogle Scholar
- 21.Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA et al (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366(9488):809–817. doi: 10.1016/S0140-6736(05)67214-5 PubMedCrossRefGoogle Scholar
- 24.Ries T, Buhk JH, Kucinski T, Goebell E, Grzyska U, Zeumer H et al (2006) Intravenous administration of acetylsalicylic acid during endovascular treatment of cerebral aneurysms reduces the rate of thromboembolic events. Stroke 37(7):1816–1821. doi: 10.1161/01.STR.0000226933.44962.a6 PubMedCrossRefGoogle Scholar
- 25.Coller BS, Peerschke EI, Scudder LE, Sullivan CA (1983) A murine monoclonal antibody that completely blocks the binding of fibrinogen to platelets produces a thrombasthenic-like state in normal platelets and binds to glycoproteins IIb and/or IIIa. J Clin Invest 72(1):325–338. doi: 10.1172/JCI110973 PubMedCrossRefGoogle Scholar
- 26.Qureshi AI, Saad M, Zaidat OO, Suarez JI, Alexander MJ, Fareed M et al (2002) Intracerebral hemorrhages associated with neurointerventional procedures using a combination of antithrombotic agents including abciximab. Stroke 33(7):1916–1919. doi: 10.1161/01.STR.0000019423.08947.43 PubMedCrossRefGoogle Scholar
- 28.Adams HP Jr, Effron MB, Torner J, Davalos A, Frayne J, Teal P 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(1):87–99. doi: 10.1161/STROKEAHA.106.476648 PubMedCrossRefGoogle Scholar
- 29.Blankenship JC, Hellkamp AS, Aguirre FV, Demko SL, Topol EJ, Califf RM (1998) Vascular access site complications after percutaneous coronary intervention with abciximab in the Evaluation of c7E3 for the Prevention of Ischemic Complications (EPIC) Trial. Am J Cardiol 81(1):36–40. doi: 10.1016/S0002-9149(97)00796-0 PubMedCrossRefGoogle Scholar