Abstract
The off-label use of drugs and devices in neuroendovascular procedures is common. Neurointerventionalists should be well aware of the level of evidence available in support of the off-label use of drugs and devices in their practice and some of the potential adverse events associated with them. These uses are categorized as I or II if they have been evaluated as primary or ancillary interventions in prospective trials/registries of neuroendovascular procedures and III if they were evaluated in case series. Category IV use is based on evaluation as primary or ancillary interventions in prospective trials/registries of non-neuroendovascular procedures. Physicians are allowed to use off-label drugs and procedures if there is strong evidence that they are beneficial for the patient. The neurointerventional professional societies agree that off-label use of drugs and devices is an important part of the specialty, but practicing providers should base their decisions on sound evidence when using such drugs and devices.
Highlights
A recent small retrospective study showed that a bivalirudin bolus of 0.6 mg/kg followed by an infusion of 1.25 mg/kg/h until the target activated coagulation time was achieved was a safe alternative to heparin infusion for anticoagulation during neuroendovascular procedures.[43]
The Apollo Stent for Symptomatic Atherosclerotic Intracranial Stenosis (ASSIST) study reported that stent-delivery failure was more frequent in lesions of Ͼ10 mm compared with those of Ͻ10 mm (25% versus 3%), though no relationship could be demonstrated with periprocedural stroke and death
Angioplasty balloon catheters can be grouped into 5 categories, as follows: standard (0.035-inch) balloon catheters, small-vessel (0.014/0.018-inch) balloon catheters, high-pressure balloon catheters, large-vessel balloon catheters, and special angioplasty balloon catheters.[84]
Summary
Intra-arterial or intravenous use of verapamil, nimodipine (Nimotop), and nicardipine (Cardene; Baxter Healthcare, Deerfield, Illinois) have all been reported to be effective and safe in the treatment of cerebral vasospasm (category III).[10,32,33,34,35] The offlabel use of calcium channel blockers in treating cerebral vasospasm is recognized as a generally accepted medical practice within the physician community; the treating physician. Physicians must be familiar with and prepared to address commonly observed adverse events of hypotension and bradycardia. These agents are all category C medications during pregnancy
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