Abstract
Background: Glycoprotein IIB/IIIA inhibitors are occasionally utilized during carotid artery stenting (CAS) in the presence or absence of a visualized intra-operative thrombus.Objective: We assess the hemorrhagic and clinical outcomes associated with the use of eptifibatide during CAS.Methods: A retrospective analysis of prospectively collected data on patients with the diagnosis of carotid artery stenosis underwent CAS in a single center. We identified those who received intravenous eptifibatide intra-operatively and compared to the rest of the cohort. Hemorrhagic outcomes included intracerebral hemorrhage (ICH) or groin hematoma that occurred during the hospital stay.Results: In this analysis, 81 patients had CAS during a 3-year span; 16 of those had received 15 mg of intravenous eptifibatide intra-operatively. The mean age of the treated and untreated patients was similar (65.6 ± 13.4 versus 65.4 ± 10.2; P = 0.13). One patient (1.2%) in this series had ICH in the perioperative period that occurred in the non-eptifibatide group. Five patients (6.2%) in this series had groin hematoma; only one in the non-eptifibatide group required surgical repair. No mortality was reported and clinical outcomes including discharge modified Rankin scale, NIH stroke scale, as well as discharge destination were similar in both groups. A stratified analysis among those who underwent an urgent CAS showed no significant differences in the risks of hemorrhages or any clinical outcome (P > 0.05).Conclusion: The use of eptifibatide during CAS is safe. The risk of any hemorrhagic complication is rare in this series; however, a prospective study to validate this observation will be helpful.
Highlights
One patient (1.2%) in this series had intracerebral hemorrhage (ICH) in the perioperative period that occurred in the non-eptifibatide group
No mortality was reported and clinical outcomes including discharge modified Rankin scale, NIH stroke scale, as well as discharge destination were similar in both groups
In-stent thrombosis is a potential problem associated with carotid artery stenting (CAS); a process attributed to intimal injury during percutaneous arterial interventions resulting in platelet activation and thrombus formation (Gawaz et al, 1996)
Summary
In-stent thrombosis is a potential problem associated with carotid artery stenting (CAS); a process attributed to intimal injury during percutaneous arterial interventions resulting in platelet activation and thrombus formation (Gawaz et al, 1996). Some of these processes occur intra-operatively and can be visualized angiographically. Glycoprotein (GP) IIb/IIIa antagonists are a group of drugs that are employed during percutaneous interventional procedures; they work by binding to the GP IIb/IIIa receptors with subsequent inhibition of platelet aggregation and thrombus formation. Glycoprotein IIB/IIIA inhibitors are occasionally utilized during carotid artery stenting (CAS) in the presence or absence of a visualized intra-operative thrombus
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