Ahead of Print: Tirofiban in Stent-Assisted Coil Embolization
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.
From: Safety and Efficacy of Tirofiban in Stent-Assisted Coil Embolization of Intracranial Aneurysms by Chalouhi et al.