Intraarterial administration of Abciximab for thromboembolic events occurring during aneurysm coil placement

Abstract

Background and purpose: Platelet-derived thrombi may occur during intracranial aneurysm coiling. We report a series of 13 patients treated with intraarterial Abciximab for thrombus formation complicating aneurysm coiling.

Methods: Four patients were treated for acutely ruptured aneurysms. Three procedures consisted of the retreatment of previously coiled aneurysms. Six patients had asymptomatic untreated aneurysms. Abciximab was administered intraarterially through a microcatheter as a bolus of 4-10 mg over a period of 10-20 minutes. All patients underwent postthrombolysis control angiography. They also underwent immediate pre- and postoperative cranial CT.

Results: In 10/13 cases, the thrombi developed without coil protrusion into the parent artery. In one case, the thrombus was generated from the guiding catheter and embolized remote from the aneurysm site. In one case, the thrombus developed before any coil placement. In another patient, a coil loop protruded into the parent artery favoring a heightened thrombotic state. Arterial thrombi were totally occlusive in two patients, whereas in the remaining 11 cases, the thrombi were not totally obstructive. Complete recanalization was achieved in 92% (12/13) of cases within 20-30 minutes. Incomplete arterial reopening was noted in one case, in which a thrombus fragment embolized distally, causing cerebral infarction. There were no Abciximab-related intracranial hemorrhages.

Conclusion: Intraarterial Abciximab was effective in this series for the treatment of thrombotic complications occurring during aneurysm coiling.

Fig 1.

Case 8. A, Left ICA (best projection), showing a ruptured anterior communicating artery (AcoA) aneurysm before the embolization treatment. B, Left ICA (best projection) after aneurysm coiling, showing an obstructive thrombus (arrowhead) at the origin of the AcoA. C, Left ICA (best projection) 20 minutes after the local delivery of 4 mg of Reopro, showing the restoration of the arterial flow in the AcoA and the right A2 segment.

Fig 2.

Case 5. A, Left ICA (best projection), showing a ruptured supraclinoid ICA at the origin of the posterior communicating artery. B, Left ICA (best projection) after aneurysm, coiling showing a nonocclusive thrombus (arrow) into the ICA lumen (arrow). C, Left ICA (best projection) 30 minutes after the local delivery of 4 mg of Reopro, showing that the thrombus has been desegregated.