The use of abciximab in the treatment of acute cerebral thromboembolic events during neuroendovascular procedures.
BACKGROUND
Recently, a great interest has emerged regarding the use of abciximab for treatment of stroke. Thromboembolic events that occur during neuroendovascular procedures represent a unique subset of stroke patients because definitive angiographic diagnosis and treatment can be performed immediately. The existing literature on this situation suggests excellent results; however, most publications are case reports, and the largest series is 13 cases. We report our experience using abciximab in the treatment of acute thromboembolic events that occur during neuroendovascular procedures.


METHODS
We reviewed the last 1373 consecutive patients who underwent neuroendovascular procedures at the University of Florida from our prospectively maintained clinical database. Of these patients, 29 (2.11%) endovascular cases were complicated by acute cerebral thromboembolic events that were treated with abciximab. Abciximab was administered in less than 1 hour after the onset of the occlusion in every patient. The Thrombolysis In Myocardial Infarction (TIMI) scale was used to measure immediate angiographic outcome, and the Modified Rankin Scale (MRS) was used to measure clinical outcome at the time of follow-up. Independent outcome was defined as an MRS of 3 or less at follow-up.


RESULTS
Angiographic improvement in the TIMI grade was achieved in 29 (81%) of 36 arteries. Three intracerebral hemorrhages occurred with abciximab when administered with concurrent mechanical clot disruption; in two of these hemorrhages, recombinant tissue plasminogen activator (r-tPA) was also administered. The mean follow-up time for the living cohort was 7.54 months. Twenty-four (83%) patients were independent at follow-up, 3 (10%) were dependent at follow-up, and 2 (7%) died.


CONCLUSIONS
Abciximab appears to be safe and effective in the treatment of acute cerebral thromboembolic complications during neuroendovascular procedures.
Department of Neurological Surgery, University of Florida College of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA.
Gregory J
GJ
Velat
Matthew V
MV
Burry
Eric
E
Eskioglu
Rebecca R
RR
Dettorre
Christopher S
CS
Firment
Robert A
RA
Mericle
D000077284:Abciximab; D000208:Acute Disease / Q000628:therapy; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000494:pharmacology* / Q000627:therapeutic use; D001488:Basilar Artery / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery; D002536:Cerebral Arteries / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D004359:Drug Therapy, Combination; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000494:pharmacology* / Q000627:therapeutic use; D002532:Intracranial Aneurysm / Q000601:surgery; D007431:Intraoperative Complications / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D011795:Surveys and Questionnaires; D013923:Thromboembolism / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator; D000077284:Abciximab