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. 2012 Mar;14(1):5-10.
doi: 10.7461/jcen.2012.14.1.5. Epub 2012 Mar 31.

Intraarterial tirofiban thrombolysis for thromboembolisms during coil embolization for ruptured intracranial aneurysms

Jin Sue Jeon  1 , Seung Hun Sheen, Gyojun Hwang, Suk Hyung Kang, Dong Hwa Heo, Yong Jun Cho
Affiliations

Intraarterial tirofiban thrombolysis for thromboembolisms during coil embolization for ruptured intracranial aneurysms

Jin Sue Jeon et al. J Cerebrovasc Endovasc Neurosurg. 2012 Mar.

Abstract

Objective: Thromboembolus can occur during endovascular coil embolization. The aim of our study was to show our experience of intraarterial (IA) tirofiban infusion for thromboembolism during coil embolization for ruptured intracranial aneurysms.

Methods: This retrospective analysis was conducted in 64 patients with ruptured aneurysms who had emergent endovascular coil embolization from May 2007 to April 2011 at a single institute. Thromboembolic events were found in ten patients (15.6%). Anticoagulation treatment with intravenous heparin was started after the first coil deployment in ruptured aneurysmal sac. When a thrombus or embolus was found during the procedure, we tried to resolve them without delay with an initial dosage of 0.3 mg of tirofiban up to 1.2 mg.

Results: Three patients of four with total occlusion had recanalizations of thrombolysis in myocardial infarction (TIMI) grade III and five of six with partial occlusion had TIMI grade III recanalizations. Eight patients showed good recovery, with modified Rankin Scale (mRS) score of 0 and one showed poor outcome (mRS 3 and 6). There was no hemorrhagic or hematologic complication.

Conclusion: IA tirofiban can be feasible when thromboembolic clots are found during coil embolization in order to get prompt recanalization, even in patients with subarachnoid hemorrhage.

Keywords: Aneurysm coiling; Intracranial aneurysm; Thromboembolism; Tirofiban.

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Figures

Fig. 1
Fig. 1
A 43-year-old female (patient 1) presented with subarachnoid hemorrhage (Hunt and Hess grade III, Fisher grade III). A 3.5 × 3.5 mm-sized aneurysm is found on the anterior communicating artery (A). During coil packing, a thrombus is detected in the proximal A2 lesion of the anterior cerebral artery (B). Nearly complete occlusion of the artery is found (C). The patency of blood flow is restored with an infusion of tirofiban (0.3 mg) (D).
See this image and copyright information in PMC

References

    1. Aster RH, Curtis BR, Bougie DW, Dunkley S, Greinacher A, Warkentin TE, et al. Thrombocytopenia associated with the use of GPIIb/IIIa inhibitors: position paper of the ISTH working group on thrombocytopenia and GPIIb/IIIa inhibitors. J Thromb Haemost. 2006 Mar;4(3):678–679. - PubMed
    1. Aviv RI, O'Neill R, Patel MC, Colquhoun IR. Abciximab in patients with ruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2005 Aug;26(7):1744–1750. - PMC - PubMed
    1. Bougie DW, Wilker PR, Wuitschick ED, Curtis BR, Malik M, Levine S, et al. Acute thrombocytopenia after treatment with tirofiban or eptifibatide is associated with antibodies specific for ligand-occupied GPIIb/IIIa. Blood. 2002 Sep;100(6):2071–2076. - PubMed
    1. 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. 2006 Jun-Jul;27(6):1326–1331. - PMC - PubMed
    1. 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. 1998 Jan;19(1):157–165. - PMC - PubMed