Intraarterial abciximab for treatment of thromboembolism during coil embolization of intracranial aneurysms: outcome and fatal hemorrhagic complications.

Abstract

OBJECT:

Experience with intraarterial abciximab for the treatment of thromboembolism during endovascular coil embolization is limited. The authors report the outcome of intraarterial abciximab use, with an emphasis on fatal hemorrhagic complications.

METHODS:

Between March 2003 and May 2006, the authors treated 606 aneurysms by using endovascular coil embolization, and in 32 (5.3%) of these aneurysms (31 patients) an intraarterial thrombus developed. Sixteen of these aneurysms were ruptured and the other 16 were unruptured. Arterial thrombi were totally occlusive in 3 and partially occlusive in the remaining 29 cases. Intraarterial abciximab was administered at a concentration of 0.2 mg/ml as a bolus of 4-15 mg over a period of 15-30 minutes.

RESULTS:

Complete thrombolysis was achieved in 17 (53%) and partial thrombolysis in 15 (47%) of 32 lesions. Twenty-eight patients (90.3%) were asymptomatic after abciximab thrombolysis, but 3 had postprocedural rebleeding that occurred after abciximab treatment; all of these patients had recently experienced an aneurysm rupture. Of these patients, 1 displayed severe thrombocytopenia and the other 2 showed a > 25% reduction in platelet count after abciximab treatment.

CONCLUSIONS:

Intraarterial abciximab is effective for the treatment of thromboembolic complications that occur during intracranial aneurysm coil insertion. Nevertheless, attention should be paid to prevent potentially fatal complications such as thrombocytopenia and hemorrhage, especially in patients with a ruptured aneurysm.

• Authors: Jae Hyo Park, Jeong Eun Kim, Seung Hun Sheen, Cheol Kyu Jung, Bae Ju Kwon, O-Ki Kwon, Chang Wan Oh, Moon Hee Han, Dae Hee Han
• Journal: Journal of neurosurgery (J Neurosurg) Vol. 108 Issue 3 Pg. 450-7 (Mar 2008) ISSN: 0022-3085 [Print] United States
• PMID: 18312090 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Immunoglobulin Fab Fragments
• Platelet Aggregation Inhibitors
• Abciximab

Topics

• Abciximab
• Adult
• Aged
• Aged, 80 and over
• Antibodies, Monoclonal (administration & dosage, adverse effects)
• Cohort Studies
• Embolization, Therapeutic (adverse effects, instrumentation, mortality)
• Female
• Humans
• Immunoglobulin Fab Fragments (administration & dosage, adverse effects)
• Infusions, Intra-Arterial
• Intracranial Aneurysm (mortality, therapy)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Subarachnoid Hemorrhage (etiology, mortality, therapy)
• Survival Rate
• Thromboembolism (drug therapy, etiology, mortality)
• Treatment Outcome