title: Intra-arterial versus intravenous abciximab therapy for thromboembolic complications of neuroendovascular procedures: case review and meta-analysis.
abstract: BACKGROUND
  Abciximab is used to treat thromboembolic complications of neuroendovascular procedures, but outcomes of treatment are not well defined.
  
  
  OBJECTIVE
  To examine the angiographic and clinical outcomes based on route of abciximab administration and degree of vessel recanalization.
  
  
  METHODS
  A prospectively maintained database of neuroendovascular procedures performed between January 2004 and May 2015 was retrospectively reviewed to identify cases with thromboembolic complications treated with abciximab. In these cases, route of administration, degree of vessel recanalization, and presence or absence of infarction were determined. A meta-analysis of similar cases in the literature was also performed.
  
  
  RESULTS
  Abciximab was administered in 0.24% (47 of 19 566) of procedures to treat thromboemboli in 59 vessels. Angiographic improvement was seen in 94% after IA therapy and 79% after IV therapy (p=0.133). In our meta-analysis of 391 treated patients, angiographic improvement was greater after IA (91.7%) than IV (77.4%) treatment (p<0.001). Postprocedural infarction occurred more frequently with distal lesions (42%) than local lesions (12%) (p=0.014), and occlusive lesions (36%) than non-occlusive lesions (4.8%) (p=0.010). Infarction was significantly less common with complete angiographic resolution (0%) than with partial or no improvement (54%) (p<0.001). Symptomatic intracranial hemorrhage occurred in 2.1%.
  
  
  CONCLUSIONS
  Abciximab produces a high rate of angiographic improvement and a low incidence of postprocedural infarct in neuroendovascular procedures complicated by thromboemboli. IA abciximab produces greater angiographic improvement than IV treatment. Postprocedural infarction is less common in patients with complete angiographic response than in those with partial or no response.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Akash P
authors.identifier: http://orcid.org/0000-0002-9201-4551
authors.initials: AP
authors.lastname: Kansagra
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: McEachern
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Madaelil
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Adam N
authors.initials: AN
authors.lastname: Wallace
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA.|Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: DeWitte T
authors.initials: DT
authors.lastname: Cross
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA.|Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Moran
authors.affiliation: Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Derdeyn
mesh_terms: D000077284:Abciximab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000601:surgery; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D020521:Stroke / Q000601:surgery; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab
keywords: Angiography; Brain; Complication; Embolic; Thrombolysis