Document Detail


Safety and Efficacy of Tirofiban in Stent-Assisted Coil Embolization of Intracranial Aneurysms.
MedLine Citation:
PMID:  22668886     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Thromboembolic complications are a major concern in stent-assisted coiling (SAC) of intracranial aneurysms that may be prevented with adequate antiplatelet therapy. OBJECTIVE:: To assess the safety and efficacy of tirofiban in SAC. METHODS:: Two protocols were used. In the initial protocol, tirofiban was administered intravenously as a 0.4 mcg/kg/min bolus for 30 min followed by 0.10 mcg/kg/min maintenance infusion. The revised protocol consisted of a 0.10 mcg/kg/min maintenance infusion alone. RESULTS:: 67 patients received tirofiban, 16 under the initial 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%) 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 CT 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.
Authors:
Nohra Chalouhi; Pascal Jabbour; David Kung; David Hasan
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-4
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania 2Department of Neurosurgery, University of Iowa, Iowa City, Iowa.
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