Intracarotid abciximab injection to abort impending ischemic stroke during carotid angioplasty.
BACKGROUND
Abciximab, a platelet glycoprotein IIb/IIIa receptor antagonist, prevents ischemic complications during percutaneous transluminal coronary angioplasty and was recently shown to open occluded vessels in patients with acute myocardial infarction when used alone or in combination with other thrombolytic agents. In an animal model of arterial thrombosis, abciximab was found to be safe and effective for the prevention of carotid artery thrombosis. However, the safety and efficacy of abciximab in the treatment of acute ischemic cerebrovascular events is unknown at present.


METHODS
We describe 3 patients who experienced ischemic cerebrovascular events with symptoms involving the middle cerebral artery territory while undergoing percutaneous angioplasty and stenting to their internal carotid arteries. Abciximab was administered to each patient within 10 min of symptom onset as a bolus (0.25 mg/kg) into the ipsilateral common carotid artery followed by continuous intravenous infusion (9 microg/min) for 12 h. All patients' symptoms resolved completely (by 25 min, 40 min and 5 h, respectively) with no further neurological complications.


CONCLUSIONS
Our preliminary observation suggests that abciximab may improve neurological outcome following middle cerebral artery ischemic events associated with carotid angioplasty and stenting. Large prospective studies are warranted to establish the safety and efficacy of abciximab in acute ischemic stroke, either as a primary treatment modality or an adjunct to carotid angioplasty and stenting.
Ho
D S
DS
Division of Cardiology, Queen Mary Hospital Department of Medicine, The University of Hong Kong, Hong Kong. dswho@hku.hk
Wang
Y
Y
Chui
M
M
Wang
Y
Y
Ho
S L
SL
Cheung
R T
RT
D000077284:Abciximab; D000368:Aged; D017130:Angioplasty; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000517:prevention & control*; D017536:Carotid Artery, Common / Q000601:surgery*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D007269:Injections, Intra-Arterial; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D020768:Middle Cerebral Artery / Q000473:pathology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D015607:Stents; D020521:Stroke / Q000517:prevention & control*; D015899:Tomography, Emission-Computed, Single-Photon
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab