Abciximab after IV rt-PA for Fluctuating Lacunar Syndrome (P07.005)

Abstract

Objective: To assess the safety and feasibility of combining IV rt-PA with IV abciximab within a 24 hour period for treatment of worsening lacunar syndromes. Background Lacunar strokes are often preceded by warning syndromes and are a major cause of progressive motor deficit. Some controversy exists about the correct management of Fluctuating Lacunar Syndromes (FLS). We present our experience using IV abciximab within 24 hours of IV rt-PA thrombolysis for FLS. Design/Methods: We retrospectively identified all patients who received IV rt-PA followed by IV abciximab within a 24hr period. We excluded all patients who received IA rt-PA, mechanical thromboembolectomy, and a longer time period between rt-PA and abciximab. We identified the NIHSS score at four different times: at presentation, after IV rt-PA, before IV abciximab, and at discharge; we also reviewed imaging reports for any evidence of hemorrhagic conversion. Results: 18 patients received IV rt-PA followed by IV abciximab within 24 hours. All four NIHSS scores were recorded in 12 patients; the remaining 6 patients only had documentation of deterioration after IV rt-PA, without specific score mentioned. The overall mean admission score was 9, and the mean improvement post-TPA was a decrease of 4 (in the 12 patients). For those 12 patients, the mean deterioration post-TPA was an increase of 4, indicating a return to pre-thrombolytic stroke severity. After IV abciximab, the mean score at discharge (for all patients) was 3, for an overall improvement of 6, from admission to discharge. No hemorrhagic conversions were identified, either after IV rt-PA or after IV abciximab. Conclusions: No therapeutic options currently exist for lacunar stroke patients who deteriorate after thrombolysis with IV rt-PA. Our results suggest that abciximab may be beneficial and safe for this population. Larger randomized trials will need to be conducted to prove safety and efficacy. Disclosure: Dr. Nair has nothing to disclose. Dr. McNeil has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Jahnel has received personal compensation for activities with Genetech as a Consultant. Dr. Stapel has nothing to disclose. Dr. Stapel has nothing to disclose. Dr. Stapel has nothing to disclose. Dr. Stapel has nothing to disclose. Dr. Hodges has nothing to disclose. Dr. Beck has nothing to disclose. Dr. Alanis has nothing to disclose. Dr. Talkad has received personal compensation for activities with Genentech, Inc. as a speaker. Dr. Wang has received personal compensation for activities with Sanofi-Aventis Pharmaceuticals, Inc. and Boehringer Ingelheim Pharmaceuticals, Inc.