J Cerebrovasc Endovasc Neurosurg.  2012 Mar;14(1):5-10. 10.7461/jcen.2012.14.1.5.

Intraarterial Tirofiban Thrombolysis for Thromboembolisms During Coil Embolization for Ruptured Intracranial Aneurysms

Affiliations
  • 1Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea. neurosheen@gmail.com

Abstract


OBJECTIVE
Thromboembolus can occur during endovascular coil embolization. The aim of our study was to show our experience of intraarterial (IA) tirofiban infusion for thromboembolism during coil embolization for ruptured intracranial aneurysms.
METHODS
This retrospective analysis was conducted in 64 patients with ruptured aneurysms who had emergent endovascular coil embolization from May 2007 to April 2011 at a single institute. Thromboembolic events were found in ten patients (15.6%). Anticoagulation treatment with intravenous heparin was started after the first coil deployment in ruptured aneurysmal sac. When a thrombus or embolus was found during the procedure, we tried to resolve them without delay with an initial dosage of 0.3 mg of tirofiban up to 1.2 mg.
RESULTS
Three patients of four with total occlusion had recanalizations of thrombolysis in myocardial infarction (TIMI) grade III and five of six with partial occlusion had TIMI grade III recanalizations. Eight patients showed good recovery, with modified Rankin Scale (mRS) score of 0 and one showed poor outcome (mRS 3 and 6). There was no hemorrhagic or hematologic complication.
CONCLUSION
IA tirofiban can be feasible when thromboembolic clots are found during coil embolization in order to get prompt recanalization, even in patients with subarachnoid hemorrhage.

Keyword

Aneurysm coiling; Thromboembolism; Tirofiban; Intracranial aneurysm

MeSH Terms

Aneurysm, Ruptured
Embolism
Heparin
Humans
Intracranial Aneurysm
Myocardial Infarction
Retrospective Studies
Subarachnoid Hemorrhage
Thromboembolism
Thrombosis
Tyrosine
Heparin
Tyrosine

Figure

  • Fig. 1 A 43-year-old female (patient 1) presented with subarachnoid hemorrhage (Hunt and Hess grade III, Fisher grade III). A 3.5 × 3.5 mm-sized aneurysm is found on the anterior communicating artery (A). During coil packing, a thrombus is detected in the proximal A2 lesion of the anterior cerebral artery (B). Nearly complete occlusion of the artery is found (C). The patency of blood flow is restored with an infusion of tirofiban (0.3 mg) (D).


Cited by  1 articles

Intra-arterial and Intravenous Tirofiban Infusion for Thromboembolism during Endovascular Coil Embolization of Cerebral Aneurysm
Sang Heum Kim, Tae Gon Kim, Min Ho Kong
J Korean Neurosurg Soc. 2017;60(5):518-526.    doi: 10.3340/jkns.2016.1212.006.


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