Local Intra-Arterial Eptifibatide for Intraoperative Vessel Thrombosis during Aneurysm Coiling

V Katsaridis,C Papagiannaki,D Peios,N Skoulios,I Achoulias

doi:10.3174/ajnr.a1068

V Katsaridis, C Papagiannaki + Show 3 more

Open Access

https://doi.org/10.3174/ajnr.a1068

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Abstract

We report on our experience with the intra-arterial administration of eptifibatide for thrombolysis during aneurysm-embolization procedures. In 4 cases (3 stent-assisted coiling procedures and 1 with posthemorrhagic vasospasm), we noted the formation of thrombus occluding a vessel. We administered eptifibatide (10-15 mg) through a microcatheter proximal to the thrombus. The thrombus rapidly dissolved, resulting in the recanalization of the occluded vessels with no rethrombosis or hemorrhagic complications.

Highlights

We report on a novel treatment, the intra-arterial bolus administration of eptifibatide (Integrilin)
We retracted the tip of the microcatheter in the origin of the middle cerebral artery (MCA) and administered 10-mg (105 ␮g/kg) eptifibatide in 5 minutes, which resulted in the recanalization of the vessel in the 2 minutes (Fig 2D)
Thrombus formation is believed to be due to the presence of foreign materials in the aneurysm and in the parent artery, the electric current used for the detachment of coils, the changes in blood flow, and vessel injury

Summary

CASE REPORT

Local Intra-Arterial Eptifibatide for Intraoperative Vessel Thrombosis during Aneurysm Coiling. Case Reports In the following 4 cases of intraoperative thromboembolic complications, we administered intra-arterial eptifibatide The first of these 4 patients, a 54-year-old woman, had a ruptured left internal carotid artery (ICA) aneurysm clipped in another hospital 8 months before. At the 6-month follow-up, MR angiography showed persistent aneurysm occlusion with full patency of the BA and both PCAs. The third patient, a 47-year-old woman, had been treated with coiling at another hospital for 2 right ICA aneurysms (1 at the origin of the posterior communicating artery [PcomA] and 1 at the origin of the anterior choroidal artery [AchoA]).

INTERVENTIONAL CASE REPORT

Discussion