Abstract WP185: Intraarterial Eptifibatide as an Adjunct to Refractory Multi-Pass Mechanical Thrombectomy

Abstract

Eptifibatide is a glycoprotein IIb/IIIa inhibitor. Its intraarterial (IA) administration as adjunct therapy during mechanical thrombectomy (MT) lacks substantial supportive evidence. Objective: To identify any correlation between IA eptifibatide (135 mcg/kg) during MT and recanalization, clinical and safety outcomes. Methods: Retrospective data collection was performed at a single center. MT cases for strokes between 2020 and 2022 were reviewed. To be included, two or more passes of MT using stent retrievers in combination with aspiration must have occurred. Favorable functional outcomes were identified as mRS of 0 to 2 and NIHSS of 0 to 4 at discharge. A recanalization score of mTICI 2b to 3 was considered as successful recanalization. Any ICH within 24 hours post procedure was reported. Results: Out of 96 total patients, IA eptifibatide was used in 49 patients (51%). Tables 1 and 2 list Patients’ characteristics and outcomes in both groups, respectively. There were significantly higher chances of 2 or less passes occurring after IA eptifibatide before procedure termination (OR 5.30; 95% CI: 1.89-14.89, P 0.002). However, IA eptifibatide did not influence chances of achieving successful recanalization (OR 0.592; 95% CI:0.228-1.539, P 0.28), having a favorable functional outcome at discharge (mRS ≤ 2 OR 0.58; 95% CI: 0.52-1.38, P 0.22. NIHSS 0-4 OR 0.57; 95% CI: 0.24-1.38, P 0.22), or the occurrence of any ICH within 24 hours (OR 2.86; 95% CI: 0.71-11.52, P 0.14). Conclusion: Our findings do not support the use of IA eptifibatide in MT. Such practice could be adding unnecessary steps to a time sensitive procedure. These findings need validation by prospective randomized trials.