Article Figures & Data
Figures
- Fig 1.
Images from the case of a 54-year-old female patient with giant ophthalmic artery aneurysm remnant.
A, Right internal carotid artery injection, oblique projection. Mask artifact outlines the margin of the dense coil pack filling the giant ophthalmic artery aneurysm. The first coil has been detached within the remnant at the aneurysm base (black arrow). Note GDCs within a previously embolized middle cerebral artery bifurcation aneurysm (arrowhead).
B, After completion of the embolization procedure, control angiogram shows a small, poorly marginated, hazy opacity at the coil-parent artery interface, suggesting early thrombus formation (arrow).
C, Repeat angiogram obtained 25 minutes later shows marked increase in thrombus burden at the coil surface and in the parent artery.
D, Forty minutes after the administration of the abciximab bolus, near-complete resolution of thrombus at the coil surface can be seen.
- Fig 2.
Images from the case of a 49-year-old male patient with a basilar tip aneurysm.
A, Angiogram of the left vertebral artery, transfacial projection. The basilar tip aneurysm is packed with GDCs (short arrows). A linear filling defect with hazy margins, consistent with thrombus, is present in the distal basilar artery and extends into the right P1 segment (long arrows).
B, Angiogram of the left vertebral artery, transfacial projection. After 24 hours of heparin infusion, follow-up angiogram obtained after GDC treatment shows resolution of thrombus. However, there is partial recanalization of the aneurysm centrally.
- Fig 3.
Images from the case of a 57-year-old female patient with a superior hypophyseal artery aneurysm.
A, Control angiogram of the right internal carotid artery, contralateral transorbital oblique projection. The superior hypophyseal artery aneurysm is tightly packed with GDCs (arrowheads). Thrombus has formed at the coil-parent artery interface, manifesting as a filling defect with a lobular contour with hazy margins (white arrow).
B, Control angiogram obtained 10 minutes after the administration of the Integrilin bolus shows resolution of thrombus at the coil-parent artery interface.
Tables
- TABLE 1:
Clinical data of GDC treatment cases with thrombus forming at coil-parent artery interface
Case no. Age (yr) Sex Location Aneurysm Diameter (mm) Aneurysm Neck (mm) Ruptured Procedural Therapy Follow-up Therapy* Evidence of Stroke at Discharge 1 54 F Ophthalmic 6 × 3 5 No Abciximab Aspirin, Plavix No 2 67 F Basilar tip 5 3.5 No Abciximab Aspirin No 3 55 F Basilar tip 8 3.5 No Abciximab Aspirin, Plavix No 4 45 M Basilar tip 6 × 8 5 Yes Heparin Aspirin No 5 49 M Basilar tip 6 5 Yes Heparin Aspirin No 6 43 M Posterior communicating 12 × 20 5 Yes Heparin Aspirin No 7 39 M Posterior communicating 6 × 8 5 Yes Heparin Aspirin No 8 57 F Superior hypophyseal 10 6 No Integrilin and heparin Aspirin No 9 49 F Superior hypophyseal 12 8 No Abciximab Aspirin,Plavix No Note.—F indicates female; M, male.
* Aspirin, 325 mg/day; Plavix, 75 mg/day with 300 mg loading dose on day 1.
Case No. Imaging Findings Activated Clotting Time before Treatment (s) Initial Therapy Activated Clotting Time after Treatment (s) Findings after Anticoagulation Therapy Additional Therapy* Technical Result 1 Thrombus at coil-parent artery interface 299 Abciximab bolus and infusion Not measured Small residual thrombus Abciximab infusion for 12 hr No follow-up angiography at 24 hr 2 Thrombus at coil-parent artery interface 238 Heparin bolus, 3000 U 318 Unchanged after 30 min Abciximab bolus and infusion Resolution of thrombus at 30 min after abciximab 3 Coil loop, thrombus narrowing right P1 50% 288 Heparin infusion, 1000 U/hr 400 Resolved thrombus, coil protruding into left P1 Abciximab bolus and infusion Resolved thrombus 4 Thrombus at coil-parent artery interface, extending into distal basilar and right P1 250 Heparin bolus, 2000 U Not measured Basilar thrombus resolved after 20 min, nonocclusive thrombus right P2 Heparin infusion for 24 hr No follow-up angiography at 24 hr 5 Thrombus at coil-parent artery interface, extending into left and right P1 200 Heparin bolus, 2000 U 300 Small residual, nonocclusive thrombus right P1 Heparin infusion for 24 hr Resolution of thrombus at 24 hr 6 Thrombus at coil-parent artery interface 155 Heparin bolus, 3000 U 300 Small residual thrombus Heparin infusion for 24 hr No follow-up angiography at 24 hr 7 Thrombus at coil-parent artery interface 220 Heparin bolus, 4000 U Not measured Resolved thrombus Heparin infusion for 24 hr Resolved thrombus 8 Thrombus at coil-parent artery interface Not recorded Heparin bolus, 5000 U 270 Unchanged after 30 min Integrilin bolus and infusion Resolution of thrombus at 10 min after Integrilin 9 Thrombus at coil-parent artery interface 307 Abciximab bolus and infusion Not measured Small residual thrombus Abciximab infusion for 12 hr No follow-up angiography at 24 hr Note.—P1 indicates P1 segment; P2, P2 segment.
* Integrilin dose: bolus, 180 μg/kg; infuse, 2 μg/kg/min for 20 hr. Abciximab dose: bolus, 0.25 mg/kg; infuse, 10 μg/min for 12 hr. Heparin infusion: heparin dosed to maintain a partial thromboplastin time of 50 to 70 s.
In this issue
Jump to section
Related Articles
Cited By...
- Intra-arterial versus intravenous abciximab therapy for thromboembolic complications of neuroendovascular procedures: case review and meta-analysis
- Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms
- Characterizing patterns of endothelialization following coil embolization: a whole-mount, dual immunostaining approach
- Thromboembolic Complications in Patients with Clopidogrel Resistance after Coil Embolization for Unruptured Intracranial Aneurysms
- Silent embolism after stent-assisted coiling of cerebral aneurysms: diffusion-weighted MRI study of 75 cases
- Heparin dosing is associated with diffusion weighted imaging lesion load following aneurysm coiling
- Attributing Hypodensities on CT to Angiographic Vasospasm Is Not Sensitive and Unreliable
- Intra-arterial abciximab for the treatment of thrombus formation during coil embolization of intracranial aneurysms
- Angiographic and Clinical Outcomes in 200 Consecutive Patients with Cerebral Aneurysm Treated with Hydrogel-Coated Coils
- Abciximab Is a Safe Rescue Therapy in Thromboembolic Events Complicating Cerebral Aneurysm Coil Embolization: Single Center Experience in 42 Cases and Review of the Literature
- Bailout Stent Deployment during Coil Embolization of Intracranial Aneurysms
- Intravenous Administration of Acetylsalicylic Acid During Endovascular Treatment of Cerebral Aneurysms Reduces the Rate of Thromboembolic Events
- Response to Letter by Wong et al
- Thromboembolic Complications of Endovascular Aneurysm Occlusion Using Matrix Detachable Coils