Mechanical Solitaire Thrombectomy with Low-Dose Booster Tirofiban Injection.
OBJECTIVE
Mechanical thrombectomy using a Solitaire stent has been associated with a high recanalization rate and favorable clinical outcome in intra-arterial thrombolysis. To achieve a higher recanalization rate for mechanical Solitaire thrombectomy, we used an intra-arterial low-dose booster tirofiban injection into the occluded segment after stent deployment. We report the safety and recanalization rates for mechanical Solitaire thrombectomy with a low-dose booster tirofiban injection.


METHODS
Between February and March 2013, 13 consecutive patients underwent mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. The occlusion sites included the proximal middle cerebral artery (5 patients), the internal carotid artery (5 patients), the top of the basilar artery (2 patients) and the distal middle cerebral artery (M2 segment, 1 patient). Six patients underwent bridge treatment, including intravenous tissue plasminogen activator. Tirofiban of 250 µg was used in all patients except one (500 µg). All occluded vessels were recanalized after 3 attempts at stent retrieval (1 time, n=9; 2 times, n=2; 3 times, n=2).


RESULTS
Successful recanalization was achieved in all patients (TICI 3, n=8; TICI 2b, n=5). Procedural complications developed in 3 patients (subarachnoid hemorrhage, n=2; hemorrhagic transformation, n=1). Mortality occurred in one patient with a basilar artery occlusion due to reperfusion brain swelling after mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. Favorable clinical outcome (mRS≤2) was observed in 8 patients (61.5%).


CONCLUSIONS
Our modified mechanical Solitaire thrombectomy method using a low-dose booster tirofiban injection might enhance the recanalization rate with no additive hemorrhagic complications.
Department of Neurosurgery, Hanmaeum Changwon Hospital, Changwon, Korea.
Duck-Ho
DH
Goh
Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea.
Sung-Chul
SC
Jin
Department of Radiology, Inje University Busan Paik Hospital, Busan, Korea.
Hae Woong
HW
Jeong
Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Korea.
Sam Yeol
SY
Ha
Mechanical thrombectomy; Solitaire stent; Tirofiban