Use of abciximab for mediation of thromboembolic complications of endovascular therapy

Abstract

We describe four cases in which abciximab was used as a thrombolytic rescue agent in the setting of thrombotic events complicating interventional neuroradiologic procedures. After IV administration of abciximab, the thrombus resolved within 30 min in three cases, whereas no thrombolysis occurred in the fourth case despite the addition of intraarterial tissue plasminogen activator. Further evaluation of glycoprotein IIb-IIIa inhibitors in patients with cerebral thromboembolic events is necessary to prove clinical efficacy.

fig 1.

Left vertebral arterial angiograms obtained in a 67-year-old woman who presented for Guglielmi detachable coil (GDC) embolization of an unruptured basilar tip aneurysm. A, Image shows the thrombus on the coil loops at the aneurysm neck (arrow). B, Image obtained 30 min after bolus administration of abciximab shows complete resolution of the thrombus.

fig 2.

Left internal carotid arterial angiograms obtained in a 43-year-old woman who presented with a ruptured basilar artery aneurysm that was treated surgically. A, After angioplasty, image shows thromboembolic occlusion of a parietal branch of the left middle cerebral artery. B, Image obtained 30 min after bolus administration of abciximab depicts recanalization of occluded branches (arrows).

fig 3.

Left internal carotid arterial angiograms obtained in an 81-year-old woman who presented with a ruptured left posterior communicating artery aneurysm. A, Immediately after placement of a guiding catheter in the left internal carotid artery, emboli were noted in the left anterior and middle cerebral arteries (arrows). B, Image obtained 50 min after bolus administration of abciximab reveals no change in the angiographic appearance of the thromboemboli.

fig 4.

Carotid angiograms obtained in a 65-year-old woman who presented with a ruptured superior cerebrellar artery aneurysm. A, Shaggy thrombus formed on a carotid stent (arrows). B, Image obtained 30 min after bolus administration of abciximab shows resolution of thrombus.