Stent-Assisted Coil Embolization Using Only a Glycoprotein IIb/IIIa Inhibitor (Tirofiban) for Ruptured Wide-Necked Aneurysm Repair.
10.7461/jcen.2018.20.1.14
- Author:
Sang Hyub LEE
1
;
In Sung PARK
;
Ja Myoung LEE
;
Kwangho LEE
;
Hyun PARK
;
Chul Hee LEE
Author Information
1. Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea. gnuhpis@gnu.ac.kr
- Publication Type:Original Article
- Keywords:
Aneurysm;
Subarachnoid hemorrhage;
Endovascular procedures;
Platelet Aggregation Inhibitors;
Tirofiban;
Stents
- MeSH:
Aneurysm*;
Catheters;
Drainage;
Electronic Health Records;
Embolization, Therapeutic*;
Endovascular Procedures;
Follow-Up Studies;
Glasgow Outcome Scale;
Glycoproteins*;
Hemorrhage;
Humans;
Intracranial Aneurysm;
Neck;
Platelet Aggregation Inhibitors;
Retrospective Studies;
Rupture;
Stents;
Subarachnoid Hemorrhage;
Thrombosis
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2018;20(1):14-23
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of stent-assisted coil embolization using only a glycoprotein IIb/IIIa inhibitor (tirofiban). MATERIALS AND METHODS: We retrospectively reviewed patients with a subarachnoid hemorrhage due to ruptured wide-necked intracranial aneurysms who were treated by stent-assisted coil embolization. In all patients, the glycoprotein IIb/IIIa inhibitor tirofiban was administered just before stent deployment. Electronic medical records for these patients were reviewed for peri-procedural complications and extra-ventricular drainage catheter related hemorrhage, as well as Glasgow outcome scale (GOS) at discharge, 3 months, and 6 months follow-up were recorded. RESULTS: Fifty-one aneurysms in 50 patients were treated. The mean patient age was 64.9 years. Eighteen patients (36%) received a World Federation of Neurosurgical Societies grade of 4 or 5. The mean aneurysm size was 9.48 mm and mean dome-to-neck ratio was 1.06. No intraoperative aneurysm ruptures occurred, although five (10%) episodes of asymptomatic stent thrombosis did occur. Three patients experienced a delayed thrombo-embolic event and two a delayed hemorrhagic event. Immediate radiologic assessment indicated a complete occlusion in 29 patients, a residual neck in 19, and a residual sac in 3. Four patients (8%) died. Sixteen patients (32%) experienced a poor GOS (< 4). Two aneurysms were recanalized during the follow-up period (mean, 19 months for clinical and 18 months for angiographic follow-up). CONCLUSION: Treatment of ruptured wide-necked intracranial aneurysms via stent-assisted coil embolization with a glycoprotein IIb/IIIa inhibitor alone was found to be relatively safe and efficient.
