Intraarterially Administered Abciximab as an Adjuvant Thrombolytic Therapy: Report of Three Cases
O-Ki Kwona,
Ki Jae Leea,
Moon Hee Hanb,d,
Chang-Wan Ohc,
Dae Hee Hanc and
Young Cho Koha
a Neurovascular Center, Inje University, Seoul Paik Hospital, Seoul, Korea
b Departments of Radiology Seoul National University College of Medicine, Clinical Research Institute, Seoul, Korea
c Departments of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul, Korea
d Seoul National University Hospital, Seoul, Korea
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FIG 1. Case 1. Angiograms show an acute middle cerebral artery occlusion treated with intraarterially administered urokinase and abciximab.
A, Initial angiogram shows occlusion of the left M1 segment.
B, After the intraarterial infusion of urokinase (100,000 U), the artery is partially opened.
C, Angiogram obtained after the intraarterial infusion of urokinase (300,000 U) shows aggravation of thrombotic occlusion of the M1 segment.
D, Angiogram obtained 5 minutes after intraarterial infusion of 10 mg of abciximab shows a partial recanalization. Remaining thrombi are seen within the superior division of the middle cerebral artery.
E, Angiogram obtained another 5 minutes later shows more advanced recanalization.
F, Final angiogram shows further recanalization. Although one branch of the inferior division of the middle cerebral artery is still occluded, in lateral projection, there was no missing artery owing to well-developed collaterals (not shown).
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FIG 2. Case 2. Angiograms show a thrombotic complication that occurred during embolization with Guglielmi detachable coils; this was successfully treated with intraarterial abciximab.
A, Angiogram shows a bilobulated posterior communicating artery aneurysm.
B, Angiogram obtained after detachment of the last coil shows thrombotic occlusion of the parent artery.
C, Angiogram obtained 5 minutes after intraarterial infusion of abciximab (5 mg) through a guide catheter shows recanalization, although there remains a luminal narrowing of the parent artery due to the protruding coil mass.
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FIG 3. Case 3. Angiograms show a thrombotic complication that occurred during embolization with Guglielmi detachable coils; this was successfully treated with intraarterially administered abciximab.
A, Initial angiogram shows an anterior communicating artery aneurysm.
B, Angiogram obtained after complete occlusion with five Guglielmi detachable coils shows luminal narrowings of both A2 segments.
C, Angiogram obtained 15 minutes after intraarterial infusion of abciximab (4 mg) by means of a microcatheter shows an obvious thrombolysis. Bloodflow through the right A2 segment is completely restored.
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