Elsevier

Surgical Neurology

Volume 62, Issue 4, October 2004, Pages 304-311
Surgical Neurology

Aneurysm
Intravenous abciximab for parent vessel thrombus during basilar apex aneurysm coil embolization: Case report and literature review

https://doi.org/10.1016/j.surneu.2003.10.045Get rights and content

Abstract

Background

Parent vessel thrombus formation is a serious complication of intracranial aneurysm embolization. The management of this issue is controversial. Abciximab, a potent platelet inhibitor, has been shown to have thrombolytic effects during coronary interventions. A small number of cases have demonstrated its potential application in neuroendovascular procedures. We review the literature on the management of parent vessel thrombosis during aneurysm coil embolization and report our successful experience with the use of IV abciximab to treat parent vessel thrombus formation related to coil embolization of a basilar apex aneurysm.

Case description

A 45-year-old man presented to our center with an incidental basilar apex aneurysm. After being informed of the surgical and endovascular treatment options, he elected to undergo coil embolization of the aneurysm. During the procedure, acute thrombus was noted in the left P1 segment of the posterior cerebral artery. IV abciximab was administered, and an angiogram the following day showed complete dissolution of the clot. The patient had no neurologic sequelae.

Conclusions

IV abciximab appears to be an effective option in the management of acute parent vessel thrombus encountered during coil embolization of unruptured aneurysms. Sufficient data are lacking regarding its use in the setting of a ruptured aneurysm.

Section snippets

History

A 45-year-old man was found incidentally to have a basilar apex aneurysm while undergoing a magnetic resonance imaging study for evaluation of a minor head injury. The patient denied any history suggestive of subarachnoid hemorrhage, transient ischemic attack, or stroke. After a review of the surgical and endovascular options, the patient elected to have the aneurysm treated with coils.

Procedure

The angiogram and intervention were performed during the same procedure. Midazolam and fentanyl were

Discussion

The endovascular treatment of intracranial aneurysms has evolved dramatically over the past decade [5]. Thromboembolic events, though, remain a significant complication of this approach [21]. In a recent analysis of reported cases of aneurysm coiling since 1992, Qureshi et al identified thromboembolic complications in 127 (8.2%) of 1,547 patients [23]. The majority of these events occurred intraprocedurally and resulted in strokes in 86 patients. The outcomes for patients who experienced stroke

Acknowledgements

We thank Paul H. Dressel for preparation of the illustrations and the staff at Kaleida Gates Hospital Library for assistance in obtaining the reference articles.

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    Disclosure: Dr. Hopkins receives research support from and is a consultant for Boston Scientific and Cordis; in addition, he has a financial interest in Boston Scientific.

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