title: Is eptifibatide a safe and effective rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization? Single-center experience in 42 cases and review of the literature.
abstract: BACKGROUND
  Thromboembolic complications are the most frequent perioperative complications of endovascular treatment of intracranial aneurysms. Even if the effectiveness of glycoprotein IIb/IIIa inhibitors has been reported, the outcomes in published clinic data are contradictory. This study aims to assess the effectiveness and the safety of eptifibatide in thromboembolic complications during intracranial aneurysm embolization procedure.
  
  
  METHODS
  Between 2006 and 2012, 650 patients with intracranial aneurysm were treated using endovascular coil embolization, and in 62 cases (9.5 %), an intra-arterial thrombus developed. Glycoprotein IIb/IIIa inhibitor was administrated in 45 of them who required a rescue treatment. These 45 patients were treated with an intra-arterial bolus (0.2 mg/kg) of eptifibatide. We respectively reviewed the angiographic and clinical outcomes, and the periprocedural complications of the rescue treatment.
  
  
  RESULTS
  No intra- or early postoperative (48 h) bleeding was observed after treatment. A total recovery of the entire arterial tree (TICI 3) was established in 28 cases (62.2 %), a partial revascularization in 13 cases (28.8 %) (5 TICI 2A and 8 TICI 2B), and no revascularization or reperfusion (TICI 0 or TICI 1) in 4 cases (9 %). Eptifibatide was more effective on proximal obstructions and in-stent occlusions than on peripheral distal thrombus, which were completely disintegrated one time out of three.
  
  
  CONCLUSIONS
  Intra-operative intra-arterial use of eptifibatide does not imply an increase of hemorrhagic events. Even if eptifibatide allows for a high rate of arterial recanalization, its effectiveness seems to be less important in cases of distal occlusions.
authors.affiliation: Unité de Neurointerventionnelle, Hôpital Saint-Roch, 5 rue Pierre Devoluy, Nice, 06000, France, jsedat@yahoo.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Sedat
authors.forename: Yves
authors.initials: Y
authors.lastname: Chau
authors.forename: Lydiane
authors.initials: L
authors.lastname: Mondot
authors.forename: Richard
authors.initials: R
authors.lastname: Chemla
authors.forename: Michel
authors.initials: M
authors.lastname: Lonjon
authors.forename: Bernard
authors.initials: B
authors.lastname: Padovani
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000473:pathology / Q000517:prevention & control; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology / Q000601:surgery*; D020767:Intracranial Thrombosis / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D008297:Male; D061185:Mechanical Thrombolysis / Q000009:adverse effects* / Q000295:instrumentation; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010455:Peptides; D000077542:Eptifibatide