Neurointervention.  2016 Sep;11(2):114-119. 10.5469/neuroint.2016.11.2.114.

Mechanical Solitaire Thrombectomy with Low-Dose Booster Tirofiban Injection

• Goh DH
• Jin SC
• Jeong HW
• Ha SY

• KMID: 2350689
• DOI: http://doi.org/10.5469/neuroint.2016.11.2.114

Abstract

PURPOSE
Mechanical thrombectomy using a Solitaire stent has been associated with a high recanalization rate and favorable clinical outcome in intra-arterial thrombolysis. To achieve a higher recanalization rate for mechanical Solitaire thrombectomy, we used an intra-arterial low-dose booster tirofiban injection into the occluded segment after stent deployment. We report the safety and recanalization rates for mechanical Solitaire thrombectomy with a low-dose booster tirofiban injection.
MATERIALS AND METHODS
Between February and March 2013, 13 consecutive patients underwent mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. The occlusion sites included the proximal middle cerebral artery (5 patients), the internal carotid artery (5 patients), the top of the basilar artery (2 patients) and the distal middle cerebral artery (M2 segment, 1 patient). Six patients underwent bridge treatment, including intravenous tissue plasminogen activator. Tirofiban of 250 µg was used in all patients except one (500 µg). All occluded vessels were recanalized after 3 attempts at stent retrieval (1 time, n=9; 2 times, n=2; 3 times, n=2).
RESULTS
Successful recanalization was achieved in all patients (TICI 3, n=8; TICI 2b, n=5). Procedural complications developed in 3 patients (subarachnoid hemorrhage, n=2; hemorrhagic transformation, n=1). Mortality occurred in one patient with a basilar artery occlusion due to reperfusion brain swelling after mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. Favorable clinical outcome (mRS≤2) was observed in 8 patients (61.5%).
CONCLUSION
Our modified mechanical Solitaire thrombectomy method using a low-dose booster tirofiban injection might enhance the recanalization rate with no additive hemorrhagic complications.

Keyword

Mechanical thrombectomy; Solitaire stent; Tirofiban

MeSH Terms

Basilar Artery
Brain Edema
Carotid Artery, Internal
Hemorrhage
Humans
Methods
Middle Cerebral Artery
Mortality
Reperfusion
Stents
Thrombectomy*
Tissue Plasminogen Activator
Tissue Plasminogen Activator

Figure

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  Fig. 1 Conventional angiograms from a 58-year-old man with a proximal middle cerebral artery occlusion (Case No.7).A. Conventional angiogram shows left proximal middle cerebral artery occlusions. B and C. Serial repeated control angiogram showed no decrease in contrast filling of the occluded segment after solitaire stent deployment. D. Final control angiogram showed complete recanalization of the occluded segment after first retrieval of the solitaire stent.

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