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Thrombus Formation during Intracranial Aneurysm Coil Placement: Treatment with Intra-Arterial Abciximab

Joon K. Songa, Yasunari Niimia, Patricia M. Fernandeza, Jonathan L. Brismana, Razvan Buciuca, Mark J. Kupersmitha and Alejandro Berensteina

a From the Center for Endovascular Surgery, Hyman-Newman Institute for Neurology and Neurosurgery, Beth Israel Hospital, Singer Division, New York, NY



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  		FIG 1. Illustrative case 1.

A, Right internal carotid artery angiogram, oblique projection, unsubtracted, shows a coil loop protruding into the parent vessel.

B, Right internal carotid artery angiogram, oblique projection, subtracted view, shows a filling defect about the coil loop, indicating thrombus formation. Note the decreased antegrade flow into the supraclinoid internal carotid artery.

C, Right internal carotid artery angiogram obtained via a microcatheter injection. The image clearly shows the filling defects about the protruded coil loop and more distally.

D, After a local, low-dose (2-mg), intra-arterial infusion of abciximab through the microcatheter, thrombus dissolution is documented without evidence of distal thromboembolism.



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  		FIG 2. Illustrative case 2.

A, Nonenhanced CT scan shows subarachnoid hemorrhage and ventricular prominence.

B, Right internal carotid artery angiogram, frontal projection, shows a heart-shaped anterior communicating artery aneurysm pointing inferiorly, with filling of both anterior cerebral arteries through the anterior communicating artery.

C, Right internal carotid artery angiogram, frontal projection, shows frank extravasation of contrast material during deployment of the first coil.

D, Right internal carotid artery angiogram, frontal projection, obtained after coil placement inf the aneurysm shows no further extravasation of contrast agent. However, both anterior cerebral arteries no longer fill.

E, Right anterior cerebral artery angiogram, with a manual injection via a microcatheter, lateral projection, shows a paucity of branch filling consistent with extensive thromboembolism.

F, Right anterior cerebral artery angiogram, with a manual injection via a microcatheter, lateral projection, after local low-dose intra-arterial infusion of 5 mg of abciximab through the microcatheter, shows recanalization of the anterior cerebral artery branches.

G, Right internal carotid artery angiogram, frontal projection, after aneurysm rupture, aneurysm coil placement, and thrombolysis with intra-arterial ReoPro shows no filling of the anterior communicating artery aneurysm and normal filling of both anterior cerebral arteries.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X