Abciximab treatment modalities for thromboembolic events related to aneurysm coiling.

Abstract

BACKGROUND:

Thromboembolic complications are the most common cause of periprocedural morbidity associated with the endovascular treatment of intracranial aneurysms with detachable coils.

OBJECTIVE:

To estimate the safety and efficacy of using combined intra-arterial and intravenous abciximab to treat thrombi complicating endovascular cerebral aneurysm coil embolization.

METHODS:

In a retrospective analysis of 390 aneurysmal coiling procedures, we identified 39 patients (10.0%) with thromboembolic events related to the procedure. As the first line of treatment in 23 of these patients, abciximab was administered intra-arterially as a bolus followed by intravenous infusion over a 12-hour period. Eleven of the 23 patients were treated for ruptured aneurysms, 9 for unruptured aneurysms, and 3 for aneurysmal recanalization. Flow restoration and neurological outcome were evaluated.

RESULTS:

Amelioration as measured by the Thrombolysis in Myocardial Infarction flow grade score was achieved in 17 of 23 patients (73.9%), and no change was observed in 6 of 23 patients (26.1%). Complete recanalization was achieved in 13 patients (56.5%). A greater response to abciximab was noted for thrombi at the coil-parent artery interface, and a lesser response was noted for distal thrombi. No hemorrhagic complications were noted for any of the patients, whereas 11 patients (47.8%) showed ischemic lesions. A modified Rankin Scale score of 2 or less was achieved in 17 of 23 patients (73.9%), whereas 6 of 23 patients (26.1%) had a modified Rankin Scale score of more than 2.

CONCLUSION:

Combined intra-arterial/intravenous administration of abciximab is safe and effective for treating thromboembolic complications that occur during aneurysmal coil embolization with no hemorrhagic complications.

• Authors: Mohamed Aggour, Laurent Pierot, Krisztof Kadziolka, Philippe Gomis, Jean-Pierre Graftieaux
• Journal: Neurosurgery (Neurosurgery) Vol. 67 Issue 2 Suppl Operative Pg. 503-8 (Dec 2010) ISSN: 1524-4040 [Electronic] United States
• PMID: 21099579 (Publication Type: Journal Article)

Chemical References

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

Topics

• Abciximab
• Adult
• Aged
• Antibodies, Monoclonal (administration & dosage)
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation, methods)
• Embolization, Therapeutic (adverse effects, instrumentation, methods)
• Female
• Humans
• Immunoglobulin Fab Fragments (administration & dosage)
• Intracranial Aneurysm (complications, therapy)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (administration & dosage)
• Retrospective Studies
• Thromboembolism (drug therapy, etiology)