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Intra-Arterial Eptifibatide in the Management of Thromboembolism during Endovascular Treatment of Intracranial Aneurysms: Case Series and a Review of the Literature.
[heparin-induced thrombocytopenia]
Thromboembolic
complications
are
well
recognized
during
the
endovascular
management
of
intracranial
aneurysms
.
In
this
study
,
we
present
a
case
series
of
40
patients
with
intraprocedural
thrombotic
complications
who
were
treated
with
intra-
arterial
eptifibatide
(
IAE
)
,
and
a
review
of
the
literature
.
Twenty
-
five
patients
with
ruptured
intracranial
aneurysms
(
RIA
)
,
10
with
unruptured
intracranial
aneurysms
(
UIA
)
and
5
with
aneurysmal
subarachnoid
hemorrhage
-induced
vasospasm
(
VSP
)
received
IAE
for
intraprocedural
thrombi
during
endovascular
treatment
.
Rates
of
recanalization
,
strokes
,
and
hemorrhagic
complications
were
assessed
.
Recanalization
was
achieved
in
96
%
(
24
/
25
)
of
the
RIA
patients
[
72
%
(
18
/
25
)
complete
;
24
%
(
6
/
25
)
partial
]
,
in
100
%
(
10
/
10
)
of
the
UIA
patients
[
90
%
(
9
/
10
)
complete
;
10
%
(
1
/
10
)
partial
]
,
and
in
100
%
(
5
/
5
)
of
the
VSP
patients
[
80
%
(
4
/
5
)
complete
;
20
%
(
1
/
5
)
partial
]
.
Strokes
following
intraprocedural
thrombosis
were
coil-related
(
20
%
,
5
/
25
)
or
stent-related
(
12
%
,
3
/
25
)
in
RIA
patients
,
stent-related
(
10
%
,
1
/
10
)
in
UIA
patients
,
and
heparin-induced
thrombocytopenia
type
II
-related
(
60
%
,
3
/
5
)
or
vasospasm-related
(
20
%
,
1
/
5
)
in
VSP
patients
.
There
were
no
intracerebral
hemorrhagic
complications
in
UIA
.
Intracerebral
hemorrhage
was
observed
in
20
%
of
the
RIA
patients
(
5
/
25
)
,
all
of
whom
had
received
intra-
arterial
thrombolytics
and
/
or
high
-dose
heparin
infusion
in
addition
to
IAE
;
in
12
%
,
this
was
external
ventricular
drain-related
(
3
/
25
)
,
4
%
had
parenchymal
hematoma
type
1
(
1
/
25
)
,
and
4
%
parenchymal
hematoma
type
2
(
1
/
25
)
.
One
of
the
5
VSP
patients
,
who
had
received
argatroban
in
addition
to
IAE
,
had
parenchymal
hematoma
type
1
.
No
clinically
significant
systemic
hemorrhage
was
observed
in
this
study
.
Treatment
of
thromboembolic
complications
with
IAE
during
endovascular
management
of
aneurysms
was
effective
in
achieving
recanalization
and
overall
well
tolerated
in
this
series
.
Diseases
Validation
Diseases presenting
"heparin-induced thrombocytopenia"
symptom
heparin-induced thrombocytopenia
This symptom has already been validated