Preliminary Study of Tirofiban Infusion in Coil Embolization of Ruptured Intracranial Aneurysms.

Abstract

BACKGROUND:

There have been some reports on the use of intra-arterial tirofiban in ruptured intracranial aneurysms, but few studies have reported on the use of 24 h of intravenous tirofiban infusion in patients with subarachnoid hemorrhage.

OBJECTIVE:

To present our experience with intravenous tirofiban infusion, in the form of a monotherapy as well as in addition to intra-arterial tirofiban, as a prophylactic, and as a rescue management for thrombus in patients who have undergone embolization with coils for ruptured intracranial aneurysms.

METHODS:

Between December 2008 and January 2015, we retrospectively reviewed 249 ruptured intracranial aneurysms that were treated with coiling at our institutions. A total of 28 patients harboring 28 ruptured and 3 unruptured intracranial aneurysms underwent intravenous tirofiban infusion during or after coil embolization of an aneurysm. Intra-arterial infusion of tirofiban via a microcatheter was also performed in 26 patients.

RESULTS:

Thromboembolic formation during the procedure was detected in 25 cases. Intra-arterial tirofiban dissolved the thromboembolus under angiographic control after 10 or more minutes in 19 (76%) of 25 patients. Two intracranial hemorrhagic complications (increase in the extent of hematoma) occurred during the follow-up period. Two cases of other complications occurred: hematuria and perioral bleeding.

CONCLUSION:

Intravenous tirofiban, as a monotherapy or in addition to intra-arterial tirofiban for thrombotic complications, seems to be useful as a treatment for acute aneurysm. However, alternatives to tirofiban should be considered if an associated hematoma is discovered before a patient receives a tirofiban infusion.

• Authors: Chang Hyo Yoon, Ho-Won Lee, Young Soo Kim, Sang Won Lee, Jeong A Yeom, Jieun Roh, Seung Kug Baik
• Journal: Neurosurgery (Neurosurgery) Vol. 82 Issue 1 Pg. 76-84 (Jan 01 2018) ISSN: 1524-4040 [Electronic] United States
• PMID: 28419294 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 by the Congress of Neurological Surgeons

Chemical References

• Fibrinolytic Agents
• Tyrosine
• Tirofiban

Topics

• Adult
• Aged
• Aneurysm, Ruptured (diagnostic imaging, drug therapy)
• Embolization, Therapeutic (methods)
• Female
• Fibrinolytic Agents (administration & dosage)
• Follow-Up Studies
• Humans
• Infusions, Intra-Arterial (methods)
• Infusions, Intravenous
• Intracranial Aneurysm (diagnostic imaging, drug therapy)
• Male
• Middle Aged
• Retrospective Studies
• Tirofiban
• Treatment Outcome
• Tyrosine (administration & dosage, analogs & derivatives)