The safety and efficacy of a low dose of tirofiban for early complications during and after stent-assisted coiling of ruptured intracranial aneurysms: a propensity matching study

2022 ◽  
pp. 107132
Author(s):  
Guangchen Shen ◽  
Zhenyu Jia ◽  
Linbo Zhao ◽  
Guangdong Lu ◽  
Sheng Liu ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Low Dose ◽  
Early Complications ◽  
Safety And Efficacy ◽  
Propensity Matching ◽  
Ruptured Intracranial Aneurysms

Safety and Efficacy of Endovascular Embolization of Ruptured Intracranial Aneurysms within 72 hours of Subarachnoid Hemorrhage

2021 ◽  
Author(s):  
Xin-Yu Li ◽  
Cong-Hui Li ◽  
Ji-Wei Wang ◽  
Jian-Feng Liu ◽  
Hui Li ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Endovascular Embolization ◽  
Safety And Efficacy ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Ruptured Intracranial Aneurysms

Abstract Purpose The purpose of the study was to investigate the safety and efficacy of endovascular embolization of ruptured intracranial aneurysms within 72 hours of subarachnoid hemorrhage (SAH). Materials and methods Patients with intracranial aneurysms treated with embolization were divided into group A (n = 277), patients with ruptured aneurysms treated within 72 hours of SAH; group B (n = 138), patients with ruptured aneurysms treated beyond 72 hours; and group C (n = 93), patients with unruptured aneurysms. Results Embolization was successful in all but four patients (99.2%). The periprocedural complication rate was 36.2% in group B, significantly (p < 0.05) greater than that in group A (24.5%) or group C (11.8%). The rebleeding rate was 9.7% (6/62 patients) in groups A and B after embolization and only 0.3% (1/346 patients) in aneurysms with total or subtotal occlusion. Of these three groups of patients, 69.7% in group A, 58.7% in group B, and 76.3% in group C achieved Glasgow Outcome Scale (GOS) score of 5 or modified Rankin Scale (mRS) score of 0– to 1 at discharge. A significant difference (p < 0.05) existed in the clinical outcome between the three groups. The percentages of patients without deficits (GOS 5 or mRS 0–1) and slight disability (mRS 2) were 80.2% in group A, 81.2% in group B, and 96.7% in group C. The mortality rate was 4.3% (12/277 patients) in group A and 7.2% (10/138 patients) in group B with no significant (p = 0.21) difference. Follow-up was performed at 3 to 54 months (mean 23.2), and the recanalization rate was 28.6% (32/112 patients) in group A, 22.4% (11/49 patients) in group B, and 28.6% (16/56 patients) in group C, with no significant differences (p = 0.15). Hydrocephalus occurred in 30.5% (39/128 patients) in group B, which was significantly (p < 0.01) greater than that in group A (9.4%) or group C (2.2%). Conclusion Early embolization of ruptured cerebral aneurysms within 72 hours of rupture is safe and effective and can significantly decrease periprocedural complications compared with management beyond 72 hours. Timely management of cisternal and ventricular blood can reduce hydrocephalus incidence and improve prognosis.

Safety and efficacy of intravenous tirofiban for stent-assisted coiling in acutely ruptured intracranial aneurysms: A single center experience

2021 ◽  
pp. 159101992110424
Author(s):  
Yihui Ma ◽  
Chenguang Jia ◽  
Tingbao Zhang ◽  
Yu Feng ◽  
Xinjun Chen ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Clinical Severity ◽  
Optimal Dosage ◽  
Thromboembolic Complications ◽  
Stent Deployment ◽  
Safety And Efficacy ◽  
Single Center Experience ◽  
Grade Ii ◽  
Ruptured Intracranial Aneurysms

Background There have been few reports on the use of tirofiban in ruptured intracranial aneurysms and the results were conflicting. However, the safety and efficacy of optimal dosage and the reasonable treatment course of tirofiban have not been determined. Objective To determine the safety and efficacy of a new protocol for its prophylactic tirofiban application during the endovascular treatment of ruptured intracranial aneurysms with no oral antiplatelet medications. Methods This retrospective study was based on 105 patients with ruptured aneurysms who underwent stent-assisted coiling at our institution between August 2017 and July 2020. Intravenous tirofiban was administered to patients after stent deployment. Tirofiban was administered as an intravenous bolus (5 µg/kg) over a 3 min period immediately after stent deployment, followed by a 0.06–0.08 µg/kg/min maintenance infusion for 12–24 h. Dual oral antiplatelet therapy was overlapped with half the tirofiban dose 2 h before the cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded. Results This study included a total of 105 patients with ruptured intracranial aneurysms, who underwent stent-assisted coiling. In terms of clinical severity, a presenting Hunt–Hess clinical-grade I was observed in 47 (44.8%) cases, grade II in 19 (18.1%) cases, grade III in 30 (28.6%) cases, grade IV in 6 (5.6%) cases, and grade V in 3 (2.9%) cases. None of the patients showed a newly developed tirofiban-related intracerebral hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, or ventriculostomy-related hemorrhage. There were 3 (2.8%) patients who had thromboembolic complications. Conclusions We have determined a new protocol for prophylactic intraoperative tirofiban during the endovascular treatment of ruptured intracranial aneurysms with no oral antiplatelet medications. In our study, tirofiban showed a low risk of hemorrhagic or thromboembolic complications. Tirofiban appears to be a safe and alternative during the stent-assisted coiling of ruptured intracranial aneurysms.

Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms

2015 ◽  
Vol 8 (11) ◽  
pp. 1148-1153 ◽  
Author(s):  
Xiao-dong Liang ◽  
Zi-liang Wang ◽  
Tian-xiao Li ◽  
Ying-kun He ◽  
Wei-xing Bai ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Dual Antiplatelet Therapy ◽  
Thromboembolic Events ◽  
Maintenance Infusion ◽  
Safety And Efficacy ◽  
Fatal Hemorrhage ◽  
Ruptured Intracranial Aneurysms

BackgroundCoil embolization of intracranial aneurysms is being increasingly used; however, thromboembolic events have become a major periprocedural complication.ObjectiveTo determine the safety and efficacy of prophylactic tirofiban in patients with ruptured intracranial aneurysms.MethodsTirofiban was administered as an intravenous bolus (8.0 μg/kg over 3 min) followed by a maintenance infusion (0.10 μg/kg/min) before stent deployment or after completion of single coiling. Dual oral antiplatelet therapy (loading doses) was overlapped with half the tirofiban dose 2 h before cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded.ResultsTirofiban was prophylactically used in 221 patients, including 175 (79.19%) who underwent stent-assisted coiling and 46 (20.81%) who underwent single coiling, all in the setting of aneurysmal subarachnoid hemorrhage. Six (2.71%) cases of intracranial hemorrhage occurred, including four (1.81%) tirofiban-related cases and two (0.90%) antiplatelet therapy-related cases. There were two (0.90%) cases of fatal hemorrhage, one related to tirofiban and the other related to dual antiplatelet therapy. Thromboembolic events occurred in seven (3.17%) patients (6 stent-assisted embolization, 1 single coiling), of which one (0.45%) event occurred during stenting and six (2.72%) occurred during intravenous tirofiban maintenance. No thromboembolic events related to dual antiplatelet therapy were found.ConclusionsTirofiban bolus over 3 min followed by maintenance infusion appears to be a safe and efficient prophylactic protocol for the endovascular treatment of ruptured intracranial aneurysms and may be an alternative to intraoperative oral antiplatelet therapy, especially in the case of stent-assisted embolization.

Comparison of stent-assisted and no-stent coil embolization for safety and effectiveness in the treatment of ruptured intracranial aneurysms

2020 ◽  
Vol 133 (3) ◽  
pp. 814-820 ◽  
Author(s):  
Haewon Roh ◽  
Junwon Kim ◽  
Heejin Bae ◽  
Kyuha Chong ◽  
Jong Hyun Kim ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
High Risk ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Viable Option ◽  
Safety And Efficacy ◽  
Ruptured Aneurysms ◽  
Hemorrhagic Complications ◽  
Acute Subarachnoid Hemorrhage ◽  
Ruptured Intracranial Aneurysms

OBJECTIVEThe safety of the stent-assisted coil embolization (SAC) technique for acutely ruptured aneurysms has not been established yet. SAC is believed to be associated with a high risk of thromboembolic and hemorrhagic complications in acute subarachnoid hemorrhage (SAH). The aim of this study was to evaluate the safety and efficacy of the SAC technique in the setting of acutely ruptured aneurysm.METHODSA total of 102 patients who received endovascular treatment for acute SAH between January 2011 and December 2017 were enrolled. The SAC technique was performed in 38 of these patients, whereas the no-stent coil embolization (NSC) technique was performed in 64. The safety and efficacy of the SAC technique in acute SAH was evaluated as compared with the NSC technique by retrospective analysis of radiological and clinical outcomes.RESULTSThere were no significant differences in clinical or angiographic outcomes between the SAC and NSC techniques in patients with acute SAH. The rate of ventriculostomy-related hemorrhagic complications was higher in the SAC group than that in the NSC group (63.6% vs 12.5%; OR 12.25, 95% CI 1.78–83.94, p = 0.01). However, all these complications were asymptomatic and so small that they were only able to be diagnosed with imaging.CONCLUSIONSRuptured wide-necked aneurysms could be effectively and safely treated with the SAC technique, which showed clinical and angiographic outcomes similar to those of the NSC technique. Hence, the SAC technique with dual-antiplatelet drugs may be a viable option even in acute SAH.

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