title: Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms.
abstract: OBJECTIVE
  Acute intraprocedural thrombus formation complicating endovascular cerebral aneurysm treatment is often treated with intra-arterial or intravenous administration of thrombolytic agents or glycoprotein IIb/IIIa (GpIIb/IIIa) inhibitors. We sought to evaluate the morbidity and mortality associated with such treatments using a large multihospital database.
  
  
  METHODS
  Using the Premier Perspective Database, we examined outcomes for patients receiving endovascular coiling for ruptured and unruptured aneurysms requiring rescue therapy, defined as treatment with GpIIb/IIIa inhibitors and fibrinolytic therapy. We compared discharge status, length of stay, and complication rates across 3 groups: (1) patients receiving GpIIb/IIIa inhibitors only, (2) patients receiving fibrinolytic therapy only, and (3) patients receiving both GpIIb/IIIa inhibitors and fibrinolytics. Student t test was used to compare continuous variables, and Fisher exact test was used to compare categorical variables.
  
  
  RESULTS
  Seven-percent (254/3627) of patients treated for unruptured aneurysms received rescue therapy. When compared with patients receiving GpIIb/IIIa inhibitors alone, patients receiving only fibrinolytics had significantly higher rates of discharge to institutions other than home (37.5% [9/24] versus 7.4% [15/201]; P<0.0001). Eight-percent of patients (338/4204) treated for ruptured aneurysms received rescue therapy. When compared with patients receiving GpIIb/IIIa inhibitors alone, patients receiving only fibrinolytics had significantly higher rates of mortality (26.0% [18/69] versus 14.5% [35/241]; P=0.02) and discharge to institutions other than home (59.4% [41/69] versus 36.5% [88/241]; P<0.0001).
  
  
  CONCLUSIONS
  Pharmacological rescue therapy occurred in 7% to 8% of endovascular coiling patients with unruptured and ruptured intracranial aneurysms. Rescue therapy with thrombolytic agents resulted in significantly more morbidity and mortality than rescue therapy with GpIIb/IIIa inhibitors.
authors.affiliation: Mayo Clinic Department of Radiology, 200 SW First St, Rochester, MN 55905, USA. brinjikji.waleed@mayo.edu
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McDonald
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000628:therapy*; D016208:Databases, Factual; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013923:Thromboembolism / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents