Safety and efficacy of tirofiban in stent-assisted coil embolization of intracranial aneurysms.

Abstract

BACKGROUND:

Thromboembolic complications are a major concern in stent-assisted coiling of intracranial aneurysms that may be prevented with adequate antiplatelet therapy.

OBJECTIVE:

To assess the safety and efficacy of tirofiban in stent-assisted coiling.

METHODS:

Two protocols were used. In the initial protocol, tirofiban was administered intravenously as a 0.4 μg/kg per min bolus for 30 minutes followed by 0.10 μg·kg min maintenance infusion. The revised protocol consisted of a 0.10 μg·kg min maintenance infusion alone.

RESULTS:

Sixty-seven patients received tirofiban, 16 under the initial protocol and 51 under the revised protocol. Thirty (44.8%) patients had sustained a subarachnoid hemorrhage (SAH). Tirofiban infusion was initiated after thromboembolic events in 9 (13.4%) patients and prophylactically in 58 (86.6%). Four (6.0%) intracranial hemorrhages were noted. Three (18.8%) intracranial hemorrhages occurred with the initial protocol in patients treated electively and were fatal in 2 (66.7%) cases. The only complication (1.9%) under the revised protocol was a subclinical worsening of the computed tomographic appearance of an SAH. There was no tirofiban-related morbidity or deaths with the revised protocol. Of 9 patients that received tirofiban as a rescue treatment, 7 (77.8%) had complete and 2 (22.2%) had partial arterial recanalization. No thromboembolic events occurred in patients receiving prophylactic tirofiban.

CONCLUSION:

A bolus followed by a maintenance dose of tirofiban appears to have a high risk of cerebral hemorrhage. A maintenance infusion without an initial bolus, however, has an exceedingly low risk of hemorrhage and appears to be very safe and effective, even in the setting of SAH.

• Authors: Nohra Chalouhi, Pascal Jabbour, David Kung, David Hasan
• Journal: Neurosurgery (Neurosurgery) Vol. 71 Issue 3 Pg. 710-4; discussion 714 (Sep 2012) ISSN: 1524-4040 [Electronic] United States
• PMID: 22668886 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Platelet Aggregation Inhibitors
• Tyrosine
• Tirofiban

Topics

• Adult
• Aged
• Cerebral Hemorrhage (etiology)
• Embolization, Therapeutic (adverse effects)
• Female
• Humans
• Infusions, Intravenous
• Injections, Intravenous
• Intracranial Aneurysm (surgery)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (administration & dosage)
• Stents
• Thromboembolism (prevention & control)
• Tirofiban
• Tyrosine (administration & dosage, analogs & derivatives)