Journal article
Safety and Efficacy of Tirofiban in Stent-Assisted Coil Embolization of Intracranial Aneurysms
Neurosurgery, Vol.71(3), pp.710-714
09/01/2012
DOI: 10.1227/NEU.0b013e31826213f9
PMID: 22668886
Abstract
Abstract BACKGROUND: Thromboembolic complications are a major concern in stent-assisted coiling of intracranial aneurysms that may be prevented with adequate antiplatelet therapy. OBJECTIVE: To assess the safety and efficacy of tirofiban in stent-assisted coiling. METHODS: Two protocols were used. In the initial protocol, tirofiban was administered intravenously as a 0.4 μg/kg per min bolus for 30 minutes followed by 0.10 μg.kg−1 min−1 maintenance infusion. The revised protocol consisted of a 0.10 μg.kg−1 min−1 maintenance infusion alone. RESULTS: Sixty-seven patients received tirofiban, 16 under the initial protocol and 51 under the revised protocol. Thirty (44.8%) patients had sustained a subarachnoid hemorrhage (SAH). Tirofiban infusion was initiated after thromboembolic events in 9 (13.4%) patients and prophylactically in 58 (86.6%). Four (6.0%) intracranial hemorrhages were noted. Three (18.8%) intracranial hemorrhages occurred with the initial protocol in patients treated electively and were fatal in 2 (66.7%) cases. The only complication (1.9%) under the revised protocol was a subclinical worsening of the computed tomographic appearance of an SAH. There was no tirofiban-related morbidity or deaths with the revised protocol. Of 9 patients that received tirofiban as a rescue treatment, 7 (77.8%) had complete and 2 (22.2%) had partial arterial recanalization. No thromboembolic events occurred in patients receiving prophylactic tirofiban. CONCLUSION: A bolus followed by a maintenance dose of tirofiban appears to have a high risk of cerebral hemorrhage. A maintenance infusion without an initial bolus, however, has an exceedingly low risk of hemorrhage and appears to be very safe and effective, even in the setting of SAH.
Details
- Title: Subtitle
- Safety and Efficacy of Tirofiban in Stent-Assisted Coil Embolization of Intracranial Aneurysms
- Creators
- Nohra Chalouhi - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PennsylvaniaPascal Jabbour - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PennsylvaniaDavid Kung - Department of Neurosurgery, University of Iowa, Iowa City, IowaDavid Hasan - Department of Neurosurgery, University of Iowa, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.71(3), pp.710-714
- DOI
- 10.1227/NEU.0b013e31826213f9
- PMID
- 22668886
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Language
- English
- Date published
- 09/01/2012
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040393202771
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