Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Intra-arterial and Intravenous Tirofiban Infusion for Thromboembolism during Endovascular Coil Embolization of Cerebral Aneurysm

  • Kim, Sang Heum (Department of Neuroradiology, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kim, Tae Gon (Department of Neurosurgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kong, Min Ho (Department of Neurosurgery, Seoul Medical Center)
  • Received : 2016.12.23
  • Accepted : 2017.04.11
  • Published : 2017.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Thromboembolism is the one of the most serious complications that can occur during endovascular coil embolization of cerebral aneurysm. We report on the effectiveness and safety of intra-arterial/intravenous (IA/IV) glycoprotein IIb/IIIa inhibitor (tirofiban) infusion for treating thromboembolism during endovascular coil embolization of cerebral aneurysm. Methods : We performed a retrospective analysis of 242 patients with ruptured or unruptured cerebral aneurysms (n=264) who underwent endovascular coil embolization from January 2011 to June 2014. Thromboembolism occurred in 20 patients (7.4%), including 14 cases of ruptured aneurysms and 6 cases of unruptured aneurysms. The most common site of aneurysms was the anterior communicating artery (n=8), followed by middle cerebral artery (n=6). When we found an enlarged thromboembolism during coil embolization, we tried to dissolve it using tirofiban administered via IA and IV loading ($5{\mu}g/kg$, respectively) for 3-5 minutes followed by IV maintenance ($0.08{\mu}g/kg/min$) for approximately 4-24 hours. Results : In 4 of 5 patients with total vessel occlusion, the vessel was recanalized to Thrombolysis in Cerebral Infarction Perfusion Scale (TICI) grade 3, and in 1 patient to TICI grade 2a. In 2 patients with partial vessel occlusion and 13 patients with minimal occlusion, the vessel recanalized to TICI grade 3. Irrelevant intracerebral hemorrhage was noted in 1 patient (5%), and thromboemboli-related cerebral infarction developed in 5 patients (25%), of which only 1 (5%) was symptomatic. Conclusion : IA/IV infusion and IV maintenance with tirofiban appear to be an effective rescue treatment for thromboembolism during endovascular coil embolization in patients with ruptured or unruptured cerebral aneurysms.

Keywords

References

  1. Bizzarri F, Scolletta S, Tucci E, Lucidi M, Davoli G, Toscano T, et al. : Perioperative use of tirofiban hydrochloride (Aggrastat) does not increase surgical bleeding after emergency or urgent coronary artery bypass grafting. J Thorac Cardiovasc Surg 122 : 1181-1185, 2001 https://doi.org/10.1067/mtc.2001.117838
  2. Brinjikji W, McDonald JS, Kallmes DF, Cloft HJ : Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms. Stroke 44 : 1343-1347, 2013 https://doi.org/10.1161/STROKEAHA.111.000628
  3. Brinjikji W, Morales-Valero SF, Murad MH, Cloft HJ, Kallmes DF : Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms: a meta-analysis. AJNR Am J Neuroradiol 36 : 121-125, 2015 https://doi.org/10.3174/ajnr.A4066
  4. Bruening R, Mueller-Schunk S, Morhard D, Seelos KC, Brueckmann H, Schmid-Elsaesser R, et al. : 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 : 1326-1331, 2006
  5. Cho YD, Lee JY, Seo JH, Kang HS, Kim JE, Jung KH, et al. : Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms. Eur J Radiol 81 : 2833-2838, 2012 https://doi.org/10.1016/j.ejrad.2011.11.023
  6. Cognard C, Weill A, Castaings L, Rey A, Moret J : Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206 : 499-510, 1998 https://doi.org/10.1148/radiology.206.2.9457205
  7. Cronqvist M, Pierot L, Boulin A, Cognard C, Castaings L, Moret J : Local intraarterial fibrinolysis of thromboemboli occurring during endovascular treatment of intracerebral aneurysm: a comparison of anatomic results and clinical outcome. AJNR Am J Neuroradiol 19 : 157-165, 1998
  8. Debrun GM, Aletich VA, Kehrli P, Misra M, Ausman JI, Charbel F : Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 43 : 1281-1295; discussion 1296-1287, 1998
  9. Eskridge JM, Song JK : Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial. J Neurosurg 89 : 81-86, 1998 https://doi.org/10.3171/jns.1998.89.1.0081
  10. Fiorella D, Albuquerque FC, Han P, McDougall CG : Strategies for the management of intraprocedural thromboembolic complications with abciximab (ReoPro). Neurosurgery 54 : 1089-1097; discussion 1097-1098, 2004 https://doi.org/10.1227/01.NEU.0000119351.86658.1D
  11. Fiorella D, Thiabolt L, Albuquerque FC, Deshmukh VR, McDougall CG, Rasmussen PA : Antiplatelet therapy in neuroendovascular therapeutics. Neurosurg Clin N Am 16 : 517-540, vi, 2005 https://doi.org/10.1016/j.nec.2005.03.003
  12. Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, et al. : Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34 : e109-e137, 2003 https://doi.org/10.1161/01.STR.0000082721.62796.09
  13. Jeon JS, Sheen SH, Hwang G, Kang SH, Heo DH, Cho YJ : Intraarterial tirofiban thrombolysis for thromboembolisms during coil embolization for ruptured intracranial aneurysms. J Cerebrovasc Endovasc Neurosurg 14 : 5-10, 2012 https://doi.org/10.7461/jcen.2012.14.1.5
  14. Jeong HW, Jin SC : Intra-arterial infusion of a glycoprotein IIb/IIIa antagonist for the treatment of thromboembolism during coil embolization of intracranial aneurysm: a comparison of abciximab and tirofiban. AJNR Am J Neuroradiol 34 : 1621-1625, 2013 https://doi.org/10.3174/ajnr.A3501
  15. Kang HS, Kwon BJ, Roh HG, Yoon SW, Chang HW, Kim JE, et al. : Intraarterial tirofiban infusion for thromboembolism during endovascular treatment of intracranial aneurysms. Neurosurgery 63 : 230-237; discussion 237-238, 2008
  16. Koebbe CJ, Horowitz MB, Levy EI, Dutton K, Jungries CC, Purdy PD : Intraarterial thrombolysis for thromboemboli associated with endovascular aneurysm coiling. Report of five cases. Interv Neuroradiol 8 : 151-158, 2002 https://doi.org/10.1177/159101990200800207
  17. Marmur JD, Poludasu S, Agarwal A, Manjappa N, Cavusoglu E : Highdose tirofiban administered as bolus-only during percutaneous coronary intervention. J Invasive Cardiol 20 : 53-58, 2008
  18. Mounayer C, Piotin M, Baldi S, Spelle L, Moret J : Intraarterial administration of abciximab for thromboembolic events occurring during aneurysm coil placement. AJNR Am J Neuroradiol 24 : 2039-2043, 2003
  19. Park JH, Kim JE, Sheen SH, Jung CK, Kwon BJ, Kwon OK, et al. : Intraarterial abciximab for treatment of thromboembolism during coil embolization of intracranial aneurysms: outcome and fatal hemorrhagic complications. J Neurosurg 108 : 450-457, 2008 https://doi.org/10.3171/JNS/2008/108/3/0450
  20. Pelz DM, Lownie SP, Fox AJ : Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 19 : 1541-1547, 1998
  21. Ries T, Siemonsen S, Grzyska U, Zeumer H, Fiehler J : Abciximab is a safe rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization: single center experience in 42 cases and review of the literature. Stroke 40 : 1750-1757, 2009 https://doi.org/10.1161/STROKEAHA.108.539197
  22. Song JK, Niimi Y, Fernandez PM, Brisman JL, Buciuc R, Kupersmith MJ, et al. : Thrombus formation during intracranial aneurysm coil placement: treatment with intra-arterial abciximab. AJNR Am J Neuroradiol 25 : 1147-1153, 2004
  23. Velat GJ, Burry MV, Eskioglu E, Dettorre RR, Firment CS, Mericle RA : The use of abciximab in the treatment of acute cerebral thromboembolic events during neuroendovascular procedures. Surg Neurol 65 : 352-358, discussion 358-359, 2006 https://doi.org/10.1016/j.surneu.2005.08.024
  24. Vinuela F, Duckwiler G, Mawad M : Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86 : 475-482, 1997 https://doi.org/10.3171/jns.1997.86.3.0475
  25. Workman MJ, Cloft HJ, Tong FC, Dion JE, Jensen ME, Marx WF, et al. : Thrombus formation at the neck of cerebral aneurysms during treatment with Guglielmi detachable coils. AJNR Am J Neuroradiol 23 : 1568-1576, 2002

Cited by

  1. Stent-Assisted Coil Embolization Using Only a Glycoprotein IIb/IIIa Inhibitor (Tirofiban) for Ruptured Wide-Necked Aneurysm Repair vol.20, pp.1, 2017, https://doi.org/10.7461/jcen.2018.20.1.14
  2. Safety and Efficacy of Tirofiban in Rescue Treatment for Acute Intracranial Intraprocedural Stent Thrombosis vol.11, pp.None, 2017, https://doi.org/10.3389/fneur.2020.00492
  3. Thromboembolism during coiling of intracranial aneurysms: predictors and clinical outcome vol.15, pp.2, 2020, https://doi.org/10.5114/wiitm.2019.89118