Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Bruening, R. Articles by Mayer, T.E. Search for Related Content PubMed PubMed Citation Articles by Bruening, R. Articles by Mayer, T.E.

American Journal of Neuroradiology 27:1326-1331, June-July 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

Intraprocedural Thrombus Formation during Coil Placement in Ruptured Intracranial Aneurysms: Treatment with Systemic Application of the Glycoprotein IIb/IIIa Antagonist Tirofiban

R. Bruening, S. Mueller-Schunk, D. Morhard, K.C. Seelos, H. Brueckmann, R. Schmid-Elsaesser, A. Straube and T.E. Mayer

Departments of Neuroradiology, Klinikum GroShadern, Ludwig-Maximilian University Munich, Munich, Germany
Neurosurgery, Klinikum GroShadern, Ludwig-Maximilian University Munich, Munich, Germany
Radiology, Klinikum GroShadern, Ludwig-Maximilian University Munich, Munich, Germany
Neurological Clinic, Klinikum GroShadern, Ludwig-Maximilian University Munich, Munich, Germany
Department of Radiology, AK Barmbek, Hamburg, Germany

Address correspondence to Roland Bruening, MD, Asklepios Klinik Barmbek, Rübenkamp 220, 22291 Hamburg, Germany

BACKGROUND AND PURPOSE:When using detachable coils to treat intracranial aneurysms, thromboembolism is the most feared and frequently reported complication during or after endovascular therapy. The purpose of this study was to document the therapeutic effect of tirofiban on patency of the parent vessel, rate of rebleedings, and outcome of the patients in the setting of acute subarachnoidal hemorrhage.

METHODS:A patient data base was retrospectively reviewed to identify patients in whom thrombus occurred during endovascular treatment of ruptured cerebral aneurysms within a 34-month period and who were treated with tirofiban. All patients underwent anticoagulation with heparin during endovascular treatment procedures. Sixteen patients (age range, 52.9 ± 10.7 years; 10 women, 6 men) were identified with intraprocedural thrombus formation. The patency of the parent vessel was assessed in a retrospective analysis blinded to outcome. Eight patients received ventriculostomy and had a follow-up CT.

RESULTS: Local nonocclusive thrombus at the coil surface was detected in 5 patients, in all of whom the thrombus was dissolved. In 10 patients, partial or total occlusion of the parent vessel occurred during the intervention; in 8 of these, the vessel was recanalized completely and in 2 drug administration was assisted by mechanical means. In 1 patient, however, the occlusion persisted. No periprocedural rebleedings of the ruptured aneurysm occurred; 3 of 8 ventriculostomies had clinically silent small local bleedings.

CONCLUSION: The use of tirofiban in the setting of endovascular treatment of ruptured intracranial aneurysms to dissolve platelet aggregation seems relatively safe and effective.

This article has been cited by other articles:

				J P P Peluso, W J van Rooij, M Sluzewski, and G N Beute Coiling of basilar tip aneurysms: Results in 154 consecutive patients with emphasis on recurrent haemorrhage and re-treatment during mid- and long-term follow-up J. Neurol. Neurosurg. Psychiatry, June 1, 2008; 79(6): 706 - 711. [Abstract] [Full Text] [PDF]

				D. M. Pelz, E. I. Levy, and L. N. Hopkins Advances in Interventional Neuroradiology 2006 Stroke, February 1, 2007; 38(2): 232 - 234. [Full Text] [PDF]