Stent-Assisted Coil Embolization Using Only a Glycoprotein IIb/IIIa Inhibitor (Tirofiban) for Ruptured Wide-Necked Aneurysm Repair

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: Aneurysm; Endovascular procedures; Platelet Aggregation Inhibitors; Stents; Subarachnoid hemorrhage; Tirofiban.

Fig. 1. 53-year-old man was admitted with subarachnoid hemorrhage. His initial mentality was coma (WFNS Gr V). (A) CTA showed 15mm sized AcomA aneurysm with bleb. (B) After SAC was performed, thrombosis formation in Enterprise stent and delayed filling left A2 was detected. (C) IA Tirofiban was administered and patency of the vessel was restored. At postoperative 10 days, He suffered UGI bleeding. (D) Follow-up angiography 6 months later showed major recanalization of previous coiled aneurysm. Retreatment of recanalized aneurysm was done. WFNS Gr = World Federation of Neurosurgical Societies grade; CTA = computed tomography angiography; AComA = anterior communicating artery; SAC = stent-assisted coil embolization; IA = intra-arterial; UGI bleeding = upper gastro-intestinal bleeding.