Evaluation of glycoprotein IIb/IIIa inhibitors in carotid angioplasty and stenting.
OBJECTIVE
To review the immediate neurological and bleeding complications associated with the use of glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing extracranial carotid artery stent placement.


METHODS
A retrospective review was performed of 550 patients (321 men; mean age 71.1 years, range 28-91) who underwent carotid artery angioplasty and stent placement. Glycoprotein IIb/IIIa inhibitors were given prophylactically along with heparin to 216 patients, whose outcomes were compared to a control group of 334 patients who received intravenous heparin alone. Primary endpoints were the immediate and 30-day neurological complications, including transient ischemic attacks (TIAs), minor and major strokes, and neurologically-related deaths. The secondary endpoint was any abnormal bleeding.


RESULTS
The all stroke/neurological death rate in 216 patients treated with heparin and GP IIb/IIIa inhibitors was 6.0% (13 events) compared 2.4% (8 events) in the 334 patients in the heparin-only control group (p=0.0430). Two of the 4 neurologically-related deaths in the GP IIb/IIIa inhibitor group resulted from intracranial hemorrhages; there were no intracranial hemorrhages in the heparin-only group. There was 1 episode of extracranial bleeding in the GP IIb/IIIa inhibitor group treated with embolization. The incidences of significant puncture-site bleeding requiring transfusion were similar in the groups.


CONCLUSIONS
Neurological complications following percutaneous carotid artery interventions have been relatively few. The neurological sequelae in carotid stent patients receiving glycoprotein IIb/IIIa inhibitors were more numerous and consequential, which suggests that the use of GP IIb/IIIa inhibitors in carotid stenting should be discouraged.
Wholey
Michael Henry
MH
Department of Cardiovascular Interventional Radiology, University of Texas Health Science Center at San Antonio, 78284, USA. wholey@uthscsa.edu
Wholey
Mark Henry
MH
Eles
Gustave
G
Toursakissian
Boulis
B
Bailey
Steven
S
Jarmolowski
Chester
C
Tan
Walter A
WA
D000077284:Abciximab; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000601:surgery*; D016022:Case-Control Studies; D000077542:Eptifibatide; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000009:adverse effects*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology*; D012189:Retrospective Studies; D015607:Stents; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000009:adverse effects* / Q000031:analogs & derivatives
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D006493:Heparin; D000077466:Tirofiban; D000077542:Eptifibatide; D000077284:Abciximab