title: Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms: a meta-analysis.
abstract: OBJECTIVE
  Intraprocedural thrombus formation during endovascular treatment of intracranial aneurysms is often treated with glycoprotein IIb/IIIa inhibitors and, in some instances, fibrinolytic therapy. We performed a meta-analysis evaluating the safety and efficacy of GP IIb/IIIa inhibitors compared with fibrinolysis. We also evaluated the safety and efficacy of abciximab, an irreversible inhibitor, compared with tirofiban and eptifibatide, reversible inhibitors of platelet function.
  
  
  METHODS
  We performed a comprehensive literature search for studies on rescue therapy for intraprocedural thromboembolic complications with glycoprotein IIb/IIIa inhibitors or fibrinolysis during endovascular treatment of intracranial aneurysms. We studied rates of periprocedural stroke/hemorrhage, procedure-related morbidity and mortality, immediate arterial recanalization, and long-term good clinical outcome. Event rates were pooled across studies by using random-effects meta-analysis.
  
  
  RESULTS
  Twenty-three studies with 516 patients were included. Patients receiving GP IIb/IIIa inhibitors had significantly lower perioperative morbidity from stroke/hemorrhage compared with those treated with fibrinolytics (11.0%; 95% CI, 7.0%-16.0% versus 29.0%; 95% CI, 13.0%-55.0%; P = .04) and were significantly less likely to have long-term morbidity (16.0%; 95% CI, 11.0%-21.0% versus 35.0%; 95% CI, 17.0%-58.0%; P = .04). There was a trend toward higher recanalization rates among patients treated with glycoprotein IIb/IIIa inhibitors compared with those treated with fibrinolytics (72.0%; 95% CI, 64.0%-78.0% versus 50.0%; 95% CI, 28.0%-73.0%; P = .08). Patients receiving tirofiban or eptifibatide had significantly higher recanalization rates compared with those treated with abciximab (83.0%; 95% CI, 68.0%-91.0% versus 66.0%; 95% CI, 58.0%-74.0%; P = .05). No difference in recanalization was seen in patients receiving intra-arterial (77.0%; 95% CI, 66.0%-85.0%) or intravenous GP IIb/IIIa inhibitors (70.0%; 95% CI, 57.0%-80.0%, P = .36).
  
  
  CONCLUSIONS
  Rescue therapy with thrombolytic agents resulted in significantly more morbidity than rescue therapy with glycoprotein IIb/IIIa inhibitors. Tirofiban/eptifibatide resulted in significantly higher recanalization rates compared with abciximab.
authors.affiliation: From the Departments of Radiology (W.B., H.J.C., D.F.K.) brinjikji.waleed@mayo.edu.
authors.forename: W
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Neurosurgery (S.F.M.-V., H.J.C., D.F.K.).
authors.forename: S F
authors.initials: SF
authors.lastname: Morales-Valero
authors.affiliation: Center for Science of Healthcare Delivery (M.H.M.), Mayo Clinic, Rochester, Minnesota.
authors.forename: M H
authors.initials: MH
authors.lastname: Murad
authors.affiliation: From the Departments of Radiology (W.B., H.J.C., D.F.K.) Neurosurgery (S.F.M.-V., H.J.C., D.F.K.).
authors.forename: H J
authors.initials: HJ
authors.lastname: Cloft
authors.affiliation: From the Departments of Radiology (W.B., H.J.C., D.F.K.) Neurosurgery (S.F.M.-V., H.J.C., D.F.K.).
authors.forename: D F
authors.initials: DF
authors.lastname: Kallmes
mesh_terms: D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D057510:Endovascular Procedures / Q000009:adverse effects*; D000077542:Eptifibatide; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D002532:Intracranial Aneurysm / Q000601:surgery*; D007431:Intraoperative Complications / Q000188:drug therapy*; D008297:Male; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D013923:Thromboembolism / Q000188:drug therapy* / Q000209:etiology*; D015912:Thrombolytic Therapy / Q000379:methods; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban; D000077542:Eptifibatide; D000077284:Abciximab
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