Abstract
Thromboembolism is a recognized complication occurring during endovascular coil embolization of intracranial aneurysms. Recently, there has been much interest in glycoprotein IIb/IIIa inhibitors to treat such complications, but the evidence is limited. We reviewed our use of one such agent, abciximab, which we commonly administer and believe to be a safe and suitable rescue agent in this setting. We retrospectively reviewed cases in which abciximab was administered in our institution between 2001 and 2007. Clinical outcome was assessed by the modified Rankin Scale (mRS) at 6 months. Good outcome was defined as no significant clinical sequelae compared with baseline status or clinical improvement (mRS < 2). Poor outcome was defined as no resolution of a new clinical deficit that developed postprocedure at 6 months (mRS > 2). Angiographic appearance of thromboembolic phenomena and posttreatment outcome was assessed with the Thrombolysis in Myocardial Infarction (TIMI) scale. Thirty-eight patients were included, with good outcome observed in 30 (79%) and poor outcome in 8 (21%) patients. Angiographic improvement based on TIMI scoring was seen in 24 (63%) patients, and no improvement was seen in 14 (37%). In 4 patients (11%), good outcome was obtained at 6 months despite no angiographic improvement on TIMI. No cases of intracranial rebleed or additional neurologic deficit following administration of abciximab were encountered. In this small retrospective series, abciximab was safe and effective when used as a rescue agent for thromboembolic complications encountered during coiling of intracerebral aneurysms.
Highlights
MethodsWe retrospectively reviewed cases in which abciximab was administered in our institution between 2001 and 2007
AND PURPOSE: Thromboembolism is a recognized complication occurring during endovascular coil embolization of intracranial aneurysms
In 4 patients (11%), good outcome was obtained at 6 months despite no angiographic improvement on Thrombolysis in Myocardial Infarction (TIMI)
Summary
We retrospectively reviewed cases in which abciximab was administered in our institution between 2001 and 2007. Poor outcome was defined as no resolution of a new clinical deficit that developed postprocedure at 6 months (mRS ⬎ 2). We collected the following data: patient demographics (age, sex), World Federation of Neurosurgeons (WFNS) grade at presentation (Table 1), acute or elective procedure, site of aneurysm, indication, route and regimen of abciximab, 6-month angiography findings, immediate and long-term outcome, and complications. In this period, 38 (6.2%) patients were identified in whom abciximab was administered intraprocedurally for thromboembolic complications witnessed angiographically during coil embolization.
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