Abstract 3554: GP IIb/IIIa Inhibitor Use during Endovascular Coil Embolization: A Single Center Experience

Introduction: Acute thromboembolic event (TEE) remains a considerable complication of endovascular aneurysm treatment. We sought to evaluate the safety of Glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors for TEE during endovascular aneurysm embolization (EAE). Method: We reviewed a single-center retrospectively collected database of EAE from 7 / 2005 to 12/2010. All patients who received a GPIIb/IIIa inhibitor (abciximab or eptifibatide) were included in the analysis. Clinical, demographic, and radiographic data were retrospectively collected through chart review. TEE was defined as a partial or complete occlusion of the parent vessel at the aneurysm neck, and/or distal vessel within the parent vessel territory. Recanalization was defined as near-complete or complete resolution of vessel thrombus on angiogram. New intracerebral hemorrhage (ICH) was defined as new intraparenchymal hemorrhage finding on head CT or new area of subarachnoid hemorrhage (SAH) >1mm in thickness. Result: Among a database of 701 cases, a GPIIb/IIIa inhibitor was used in a total of 61 (8.7%) cases, of these 57 were treated for TEE and 4 were treated prophylactically for sub therapeutic platelet point of care testing. There were 41 males, and the mean age was 54 ±13 years. The TEE occurred slightly higher during ruptured aneurysm coiling (57% and 43%, p=0.07). Thirty-nine (64%) cases were treated with adjunctive devices, which included a stent (29) or balloon (10), p-value=0.001. Close to half of the TEE was not occlusive (54%). A total of 55 (90%) cases received abciximab with a mean bodyweight base dose of 0.17mg/kg, and 6 (10%) cases received eptifibatide with a mean body weight base dose of 0.15mg/kg. Nine (16%) cases required additional therapy for ongoing clot (stent (3), balloon (3), penumbra (1), intra- arterial thrombolysis (1), and vessel sacrifice (1). Forty-two (74%) cases had complete angiographic recanalization (77% using abciximab and 25% using eptifibatide, (p=0.051)). There were 10 (16%) new ICH; 3 (5%) which were symptomatic. Patients with new ICH had non significant higher mean bodyweight dose compare to patients without new ICH 0.26 0.32 mg/kg and 0.15 0.07 mg/kg respectively. Conclusion: GP IIb/IIIa inhibitor use in EAE as single and multimodal therapy for acute TEE may have acceptable safety and recanalization rates (symptomatic ICH of 5% and complete recanalization of 74%). Further study to confirm the current study findings and identify optimal dosing is needed; however these data suggest that a lower dose may be favorable.

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