Strategies for the management of intraprocedural thromboembolic complications with abciximab (ReoPro)

OBJECTIVE: Most complications related to endovascular neurointerventional procedures are thromboembolic. The objective of this study was to determine whether abciximab, a glycoprotein IIb/IIIa inhibitor, is a safe and effective agent for the treatment of thromboembolic complications encountered during interventional neuroradiological procedures. METHODS: A search of a prospectively maintained database identified 13 patients who were treated for intraprocedural thromboembolic complications with abciximab, either alone or in combination with tissue plasminogen activator, during a 2.2-month period. RESULTS: Of the 13 patients in our series (10 with aneurysms, 3 with arteriovenous malformations), 12 presented with unsecured vascular lesions, and in 9 cases the lesions were either acutely (<10 d) or subacutely (<6 mo) hemorrhagic. After the identification of a thromboembolic complication, each patient was treated with either intra-arterial (n = 5) or intravenous (n 8) abciximab. Abciximab was administered intravenously as a 0.25-mg/kg bolus (n 2), a 0.25-mg/kg bolus followed by a 12-hour 0.125-mug/kg/min infusion (n = 5), or a 12-hour 0.125-mug/kg/min infusion alone (n = 1). Intra-arterial abciximab (3.5-10 mg) was administered directly through a micro-catheter positioned in the vicinity of the thrombus (n = 5). Five patients also were administered alteplase. Complete (n = 7) or partial (n = 6) resolution of thrombus was observed in all cases. Five patients had small infarcts in the distribution of the thromboembolic complication. In no case was new or increased hemorrhaging observed after thrombolysis. CONCLUSION: Abciximab (ReoPro), administered either intravenously or intra-arterially, is a viable option for the management of thromboembolic complications encountered during endovascular therapeutic procedures.