Strategies for the Management of Intraprocedural Thromboembolic Complications with Abciximab (ReoPro)

David Fiorella, Felipe C. Albuquerque, Patrick Han, Cameron G. McDougall, Ricardo A. Hanel, L. Nelson Hopkins, Joel D. MacDonald

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Most complications related to endovascular neurointerventional procedures are thromboembolic. The objective of this study was to determine whether abciximab, a glycoprotein IIb/IIIa inhibitor, is a safe and effective agent for the treatment of thromboembolic complications encountered during interventional neuroradiological procedures. METHODS: A search of a prospectively maintained database identified 13 patients who were treated for intraprocedural thromboembolic complications with abciximab, either alone or in combination with tissue plasminogen activator, during a 22-month period. RESULTS: Of the 13 patients in our series (10 with aneurysms, 3 with arteriovenous malformations), 12 presented with unsecured vascular lesions, and in 9 cases the lesions were either acutely (<10 d) or subacutely (<6 mo) hemorrhagic. After the identification of a thromboembolic complication, each patient was treated with either intra-arterial (n = 5) or intravenous (n = 8) abciximab. Abciximab was administered intravenously as a 0.25-mg/kg bolus (n = 2), a 0.25-mg/kg bolus followed by a 12-hour 0.125-μg/kg/min infusion (n = 5), or a 12-hour 0.125-μg/kg/min infusion alone (n = 1). Intra-arterial abciximab (3.5-10 mg) was administered directly through a microcatheter positioned in the vicinity of the thrombus (n = 5). Five patients also were administered alteplase. Complete (n = 7) or partial (n = 6) resolution of thrombus was observed in all cases. Five patients had small infarcts in the distribution of the thromboembolic complication. In no case was new or increased hemorrhaging observed after thrombolysis. CONCLUSION: Abciximab (ReoPro), administered either intravenously or intra-arterially, is a viable option for the management of thromboembolic complications encountered during endovascular therapeutic procedures.

Original languageEnglish (US)
Pages (from-to)1089-1098
Number of pages10
JournalNeurosurgery
Volume54
Issue number5
DOIs
StatePublished - May 2004
Externally publishedYes

Keywords

  • Abciximab
  • Alteplase
  • Aneurysm
  • Arteriovenous malformation
  • Guglielmi detachable coils
  • Thrombolysis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Strategies for the Management of Intraprocedural Thromboembolic Complications with Abciximab (ReoPro)'. Together they form a unique fingerprint.

  • Cite this

    Fiorella, D., Albuquerque, F. C., Han, P., McDougall, C. G., Hanel, R. A., Hopkins, L. N., & MacDonald, J. D. (2004). Strategies for the Management of Intraprocedural Thromboembolic Complications with Abciximab (ReoPro). Neurosurgery, 54(5), 1089-1098. https://doi.org/10.1227/01.NEU.0000119351.86658.1D