Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Stent-Assisted Coil Embolization Using Only a Glycoprotein IIb/IIIa Inhibitor (Tirofiban) for Ruptured Wide-Necked Aneurysm Repair

  • Lee, Sang Hyub (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Park, In Sung (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Lee, Ja Myoung (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Lee, Kwangho (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Park, Hyun (Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Lee, Chul Hee (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine)
  • Received : 2018.01.16
  • Accepted : 2018.03.15
  • Published : 2018.03.31
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Abstract

Objective : The aim of this study was to evaluate the safety and efficacy of stent-assisted coil embolization using only a glycoprotein IIb/IIIa inhibitor (tirofiban). Materials and Methods : We retrospectively reviewed patients with a subarachnoid hemorrhage due to ruptured wide-necked intracranial aneurysms who were treated by stent-assisted coil embolization. In all patients, the glycoprotein IIb/IIIa inhibitor tirofiban was administered just before stent deployment. Electronic medical records for these patients were reviewed for peri-procedural complications and extra-ventricular drainage catheter related hemorrhage, as well as Glasgow outcome scale (GOS) at discharge, 3 months, and 6 months follow-up were recorded. Results : Fifty-one aneurysms in 50 patients were treated. The mean patient age was 64.9 years. Eighteen patients (36%) received a World Federation of Neurosurgical Societies grade of 4 or 5. The mean aneurysm size was 9.48 mm and mean dome-to-neck ratio was 1.06. No intraoperative aneurysm ruptures occurred, although five (10%) episodes of asymptomatic stent thrombosis did occur. Three patients experienced a delayed thrombo-embolic event and two a delayed hemorrhagic event. Immediate radiologic assessment indicated a complete occlusion in 29 patients, a residual neck in 19, and a residual sac in 3. Four patients (8%) died. Sixteen patients (32%) experienced a poor GOS (< 4). Two aneurysms were recanalized during the follow-up period (mean, 19 months for clinical and 18 months for angiographic follow-up). Conclusion : Treatment of ruptured wide-necked intracranial aneurysms via stent-assisted coil embolization with a glycoprotein IIb/IIIa inhibitor alone was found to be relatively safe and efficient.

Keywords

References

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