Thromboembolic complications are well recognized during the endovascular management of
intracranial aneurysms. In this study, we present a case series of 40 patients with intraprocedural thrombotic complications who were treated with intra-arterial
eptifibatide (IAE), and a review of the literature.
METHODS: RESULTS: Recanalization was achieved in 96% (24/25) of the RIA patients [72% (18/25) complete; 24% (6/25) partial], in 100% (10/10) of the UIA patients [90% (9/10) complete; 10% (1/10) partial], and in 100% (5/5) of the VSP patients [80% (4/5) complete; 20% (1/5) partial].
Strokes following intraprocedural
thrombosis were coil-related (20%, 5/25) or
stent-related (12%, 3/25) in RIA patients,
stent-related (10%, 1/10) in UIA patients, and
heparin-induced
thrombocytopenia type II-related (60%, 3/5) or vasospasm-related (20%, 1/5) in VSP patients. There were no intracerebral hemorrhagic complications in UIA.
Intracerebral hemorrhage was observed in 20% of the RIA patients (5/25), all of whom had received intra-arterial thrombolytics and/or high-dose
heparin infusion in addition to IAE; in 12%, this was external ventricular drain-related (3/25), 4% had parenchymal
hematoma type 1 (1/25), and 4% parenchymal
hematoma type 2 (1/25). One of the 5 VSP patients, who had received
argatroban in addition to IAE, had parenchymal
hematoma type 1. No clinically significant systemic
hemorrhage was observed in this study.
CONCLUSION: Treatment of thromboembolic complications with IAE during endovascular management of
aneurysms was effective in achieving recanalization and overall well tolerated in this series.