TY - JOUR T1 - Rescue Treatment of Thromboembolic Complications during Endovascular Treatment of Cerebral Aneurysms: A Meta-Analysis JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 121 LP - 125 DO - 10.3174/ajnr.A4066 VL - 36 IS - 1 AU - W. Brinjikji AU - S.F. Morales-Valero AU - M.H. Murad AU - H.J. Cloft AU - D.F. Kallmes Y1 - 2015/01/01 UR - http://www.ajnr.org/content/36/1/121.abstract N2 - BACKGROUND AND PURPOSE: Intraprocedural thrombus formation during endovascular treatment of intracranial aneurysms is often treated with glycoprotein IIb/IIIa inhibitors and, in some instances, fibrinolytic therapy. We performed a meta-analysis evaluating the safety and efficacy of GP IIb/IIIa inhibitors compared with fibrinolysis. We also evaluated the safety and efficacy of abciximab, an irreversible inhibitor, compared with tirofiban and eptifibatide, reversible inhibitors of platelet function. MATERIALS AND METHODS: We performed a comprehensive literature search for studies on rescue therapy for intraprocedural thromboembolic complications with glycoprotein IIb/IIIa inhibitors or fibrinolysis during endovascular treatment of intracranial aneurysms. We studied rates of periprocedural stroke/hemorrhage, procedure-related morbidity and mortality, immediate arterial recanalization, and long-term good clinical outcome. Event rates were pooled across studies by using random-effects meta-analysis. RESULTS: Twenty-three studies with 516 patients were included. Patients receiving GP IIb/IIIa inhibitors had significantly lower perioperative morbidity from stroke/hemorrhage compared with those treated with fibrinolytics (11.0%; 95% CI, 7.0%–16.0% versus 29.0%; 95% CI, 13.0%–55.0%; P = .04) and were significantly less likely to have long-term morbidity (16.0%; 95% CI, 11.0%–21.0% versus 35.0%; 95% CI, 17.0%–58.0%; P = .04). There was a trend toward higher recanalization rates among patients treated with glycoprotein IIb/IIIa inhibitors compared with those treated with fibrinolytics (72.0%; 95% CI, 64.0%–78.0% versus 50.0%; 95% CI, 28.0%–73.0%; P = .08). Patients receiving tirofiban or eptifibatide had significantly higher recanalization rates compared with those treated with abciximab (83.0%; 95% CI, 68.0%–91.0% versus 66.0%; 95% CI, 58.0%–74.0%; P = .05). No difference in recanalization was seen in patients receiving intra-arterial (77.0%; 95% CI, 66.0%–85.0%) or intravenous GP IIb/IIIa inhibitors (70.0%; 95% CI, 57.0%–80.0%, P = .36). CONCLUSIONS: Rescue therapy with thrombolytic agents resulted in significantly more morbidity than rescue therapy with glycoprotein IIb/IIIa inhibitors. Tirofiban/eptifibatide resulted in significantly higher recanalization rates compared with abciximab. GP IIb/IIIaglycoprotein IIb/IIIaIAintra-arterialTIMIThrombolysis in Myocardial Infarction ER -