Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms.
BACKGROUND
Intra-arterial (IA) thrombolytic intervention for acute thrombosis has been challenged due to the risk of bleeding during the endovascular treatment of ruptured aneurysms. We present the results of IA tirofiban infusion for thromboembolic complications during coil embolization in patients with ruptured intracranial aneurysms.


METHODS
Thromboembolic events requiring thrombolytic intervention occurred in 39 (10.5%) cases during coil embolization of 372 consecutive ruptured intracranial aneurysms. Maximal aneurysm diameters of 39 patients (mean age, 54.7 ± 13.2 years; 23 female, 16 male) ranged from 2.1 to 13.1mm (mean, 6.6 ± 3.0mm). The anterior communicating artery was the most common site (n=13), followed by the middle cerebral artery (n=9) and the posterior communicating artery (n=7). In this series, we used intracranial stents in 10 patients during the procedure. Superselective IA tirofiban infusion through a microcatheter was performed to resolve thrombi and emboli. We assessed the efficacy and safety of IA tirofiban infusion in patients with ruptured aneurysms.


RESULTS
Intraarterially administered tirofiban doses ranged from 0.25 to 1.25mg (mean, 0.71 ± 0.26 mg). Effective thrombolysis or recanalization was achieved in 34 patients (87.2%), and three patients (7.7%) suffered distal migration of clots with partial recanalization. The rest (5.1%) had no recanalization. Nonconsequent intracerebral hemorrhage occurred in two patients (5.1%) after the procedure. Thromboemboli-related cerebral infarction developed in eight patients, and only two patients remained infarction related disabilities.


CONCLUSIONS
IA tirofiban infusion seems to be efficacious and safe for thrombolysis during coil embolization in patients with ruptured intracranial aneurysms.
Department of Radiology, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 425 Sindaebang-dong, Dongjak-gu, Seoul 156-707, Republic of Korea. aronnn@naver.com
Young Dae
YD
Cho
Jong Young
JY
Lee
Jung Hwa
JH
Seo
Hyun-Seung
HS
Kang
Jeong Eun
JE
Kim
Keun Hwa
KH
Jung
Moon Hee
MH
Han
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000706:statistics & numerical data; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence; D011859:Radiography; D056910:Republic of Korea / Q000453:epidemiology; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D005343:Fibrinolytic Agents; D014443:Tyrosine; D000077466:Tirofiban