Abciximab for Treatment of Thromboembolic Complications during Endovascular Coiling of Intracranial Aneurysms

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Fig 1.
A, Thrombus formation at the origin (arrowhead) and distal total occlusion (arrow) of the right PCA in association with protrusion of a coil into the parent artery on near-completion angiography during coiling of a large basilar tip aneurysm. B, Angiogram 20-minutes post-intra-arterial abciximab demonstrates restored patency of the right PCA with a small residual amount of thrombus (arrowhead) at the aneurysm neck–parent artery interface. C, Angiogram 6 months after embolization demonstrates complete exclusion of the aneurysm and arterial patency with resolution of thrombus.
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Fig 2.
A, Precoiling angiogram demonstrates a large basilar artery aneurysm arising in close proximity to the origin of the left anterior inferior cerebellar artery. B, Mid coil-embolization of the aneurysm with a small thrombus causing a filling defect in the parent vessel (arrowhead) and near-total occlusion of the left PCA (arrow). C, Approximately 30 minutes following the administration of an intravenous bolus of abciximab, there is demonstrable restoration of flow within the left PCA.

Table 1:

WFNS grading

Score	Criteria
0	No Bleed
1	GCS 15 with no motor deficit
2	GCS 14–13 with no motor deficit
3	GCS 14–13 with a motor deficit
4	GCS 12–7 with or without motor deficit
5	GCS 6–3 with or without motor deficit
6	Dead

Table 2:

mRS score

Score	Grade Definition Stratification
0	Asymptomatic independent
1	No significant disability despite symptoms
	Able to carry out all usual duties and activities
	Independent
2	Slight disability
	Unable to carry out all previous activities
	Able to look after own affairs without assistance
	Independent
3	Moderate disability
	Requiring some help, able to walk without assistance
	Independent
4	Moderate-severe disability
	Unable to walk without assistance
	Unable to attend to bodily needs without assistance
	Dependent
5	Severe disability
	Bedridden, incontinent, and requiring constant nursing care and attention
	Dependent
6	Death
	Deceased

Table 3:

TIMI Scale

Grade	Description of Flow
0	No perfusion beyond the occlusion
1	Perfusion exists past the initial obstruction but with poor branch filling of <⅓; the normal territory
2	Partial perfusion and incomplete distal branch filling (34%–99%)
3	Full perfusion with normal filling of all distal branches in a normal hemodynamic fashion

Table 4:

Patient demographics and angiographic (TIMI), immediate clinical, and 6-month mRS outcome

Patient	Age	Sex	Site of Aneurysm	Presentation	WFNS	Bolus Route	Initial TIMI	Final TIMI	Outcome	mRS
1^*	58	F	Left MCA	Acute	1	IV	0	0	Good	1
2	32	M	AcomA	Acute	2	IV	2	3	Good	1
3^*	79	M	AcomA	Acute	1	IV	0	0	Good	1
4	35	M	Right PcomA	Acute	1	IV	0	2	Good	1
5^*	56	F	Basilar artery tip	Acute	1	IV	0	0	Good	1
6	54	F	Right PcomA	Acute	2	IV	2	2	Good	2
7	63	M	AcomA	Acute	2	IV	2	2	Poor	5
8^†	42	F	Right A2	Acute	5	IV	0	0	Poor	5
9	81	F	Right PcomA	Acute	1	IV	0	0	Poor	6
10	53	M	AcomA	Acute	1	IV	2	3	Good	1
11	46	M	AcomA	Acute	2	IV	0	0	Good	2
12	51	F	Right MCA	Elective	1	IA	0	0	Good	1
13^‡	49	F	AcomA	Acute	1	IA	0	1	Poor	3
14	54	M	Left MCA	Acute	1	IV	0	2	Good	1
15	51	M	AcomA	Acute	1	IV	2	2	Good	1
16^‡	58	M	Right PcomA	Acute	1	IV	2	3	Poor	5
17^†^‡	55	M	AcomA	Acute	4	IV	2	3	Poor	5
18	58	F	Left MCA	Elective	1	IV	0	2	Good	1
19	58	M	Right ICA Termination	Elective	1	IV	2	3	Good	2
20	40	M	AcomA	Elective	1	IV	2	2	Good	1
21	29	F	Basilar artery	Acute	1	IV	1	3	Good	1
22	56	M	Left MCA	Acute	1	IV	1	2	Good	2
23	36	M	AcomA	Acute	1	IV	0	2	Good	1
24	64	F	Left paraclinoid ICA	Acute	1	IA	0	2	Good	1
25	53	F	AcomA	Acute	1	IV	0	1	Good	2
26	48	F	AcomA	Acute	1	IV	0	0	Poor	6
27	68	M	Basilar artery tip	Acute	1	IA	2	2	Good	1
28	52	F	Left PcomA	Acute	1	IA	0	3	Good	1
29	61	F	AcomA	Acute	1	IA	2	3	Good	1
30^*	63	F	Right MCA	Acute	1	IA	0	0	Good	1
31	58	M	Right MCA	Acute	1	IA	0	3	Good	1
32^‡	51	F	Right MCA	Acute	2	IA	0	1	Poor	3
33	52	F	Left paraclinoid ICA	Elective	1	IA	2	3	Good	1
34	47	F	Basilar artery tip	Acute	1	IA	0	1	Good	1
35	44	F	AcomA	Acute	1	IA	0	2	Good	1
36	52	F	AcomA	Elective	1	IA	0	3	Good	1
37	69	M	AcomA	Acute	1	IA	1	2	Good	1
38	70	F	Right MCA	Acute	1	IA	2	3	Good	1

Note:—MCA indicates middle cerebral artery; AcomA, anterior communicating artery; PcomA, posterior communicating artery; ICA, internal carotid artery; IV, intravenous, IA, intra-arterial.
* Patients with no angiographic (TIMI) improvement but good outcome.
† Patients with a poor pretreatment WFNS grade with resulting poor outcome.
‡ Patients with angiographic (TIMI) improvement but poor outcome.