Intracranial hemorrhage following neuroendovascular procedures with abciximab is associated with high mortality: A multicenter series

Ryan D. Walsh, Kevin M Barrett, Maria I. Aguilar, Giuseppe Lanzino, Ricardo A. Hanel, David A. Miller, Brian W. Chong, W. David Freeman

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background Abciximab is being used as an adjunct to neuroendovascular procedures both to prevent and treat ischemic sequelae. Experience with abciximab in this setting is limited; major bleeding complications, including fatal intracranial hemorrhage (ICH), are of particular concern. We report our multicenter experience with ICH following the administration of abciximab during neuroendovascular procedures. Methods We identified neuroendovascular procedures (including cerebral angiograms, aneurysm coiling procedures, angioplasty/vascular stenting procedures, and emergent revascularization procedures) that used abciximab at Mayo Clinic Hospitals in Rochester, Jacksonville, and Phoenix between November 2000 and April 2009. Cases of periprocedural ICH were identified and pertinent demographic, historical, procedural, radiographic, and laboratory data were collected. Clinical outcome was measured either at death or discharge by the Glasgow Outcome Scale (GOS). Results Abciximab was used in 51 neuroendovascular procedures; 9 cases of ICH were identified. Procedures performed and indications for abciximab use varied. Route of abciximab administration included IV bolus only (n = 4), IA bolus followed by IV infusion (n = 3), IV bolus followed by IV infusion (n = 1), and IV infusion without preceding bolus (n = 1). All but 1 of the patients received concomitant periprocedural antiplatelet, anticoagulant, or thrombolytic agents. Eight of the 9 cases of ICH were detected within 7 h of abciximab administration. ICH pattern varied. Four patients died following ICH. Conclusions Adjunctive use of abciximab to prevent or treat ischemic sequelae during neuroendovascular procedures is associated with a high risk of ICH (18%). We report 9 cases of ICH associated with abciximab administration during neuroendovascular procedures with 44% mortality.

Original languageEnglish (US)
Pages (from-to)85-95
Number of pages11
JournalNeurocritical Care
Volume15
Issue number1
DOIs
StatePublished - Aug 2011

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Intracranial Hemorrhages
Mortality
abciximab
Glasgow Outcome Scale
Fibrinolytic Agents
Platelet Aggregation Inhibitors
Intracranial Aneurysm
Angioplasty
Anticoagulants
Blood Vessels
Angiography
Demography
Hemorrhage

Keywords

  • Abciximab
  • Aneurysm coiling
  • Glycoprotein IIb/IIIa (GP IIb/IIIa) receptor inhibitor
  • Intracranial hemorrhage
  • Mortality
  • Neuroendovascular
  • Neurointervention

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Intracranial hemorrhage following neuroendovascular procedures with abciximab is associated with high mortality : A multicenter series. / Walsh, Ryan D.; Barrett, Kevin M; Aguilar, Maria I.; Lanzino, Giuseppe; Hanel, Ricardo A.; Miller, David A.; Chong, Brian W.; Freeman, W. David.

In: Neurocritical Care, Vol. 15, No. 1, 08.2011, p. 85-95.

Research output: Contribution to journalArticle

Walsh, Ryan D. ; Barrett, Kevin M ; Aguilar, Maria I. ; Lanzino, Giuseppe ; Hanel, Ricardo A. ; Miller, David A. ; Chong, Brian W. ; Freeman, W. David. / Intracranial hemorrhage following neuroendovascular procedures with abciximab is associated with high mortality : A multicenter series. In: Neurocritical Care. 2011 ; Vol. 15, No. 1. pp. 85-95.
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abstract = "Background Abciximab is being used as an adjunct to neuroendovascular procedures both to prevent and treat ischemic sequelae. Experience with abciximab in this setting is limited; major bleeding complications, including fatal intracranial hemorrhage (ICH), are of particular concern. We report our multicenter experience with ICH following the administration of abciximab during neuroendovascular procedures. Methods We identified neuroendovascular procedures (including cerebral angiograms, aneurysm coiling procedures, angioplasty/vascular stenting procedures, and emergent revascularization procedures) that used abciximab at Mayo Clinic Hospitals in Rochester, Jacksonville, and Phoenix between November 2000 and April 2009. Cases of periprocedural ICH were identified and pertinent demographic, historical, procedural, radiographic, and laboratory data were collected. Clinical outcome was measured either at death or discharge by the Glasgow Outcome Scale (GOS). Results Abciximab was used in 51 neuroendovascular procedures; 9 cases of ICH were identified. Procedures performed and indications for abciximab use varied. Route of abciximab administration included IV bolus only (n = 4), IA bolus followed by IV infusion (n = 3), IV bolus followed by IV infusion (n = 1), and IV infusion without preceding bolus (n = 1). All but 1 of the patients received concomitant periprocedural antiplatelet, anticoagulant, or thrombolytic agents. Eight of the 9 cases of ICH were detected within 7 h of abciximab administration. ICH pattern varied. Four patients died following ICH. Conclusions Adjunctive use of abciximab to prevent or treat ischemic sequelae during neuroendovascular procedures is associated with a high risk of ICH (18{\%}). We report 9 cases of ICH associated with abciximab administration during neuroendovascular procedures with 44{\%} mortality.",
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T1 - Intracranial hemorrhage following neuroendovascular procedures with abciximab is associated with high mortality

T2 - A multicenter series

AU - Walsh, Ryan D.

AU - Barrett, Kevin M

AU - Aguilar, Maria I.

AU - Lanzino, Giuseppe

AU - Hanel, Ricardo A.

AU - Miller, David A.

AU - Chong, Brian W.

AU - Freeman, W. David

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N2 - Background Abciximab is being used as an adjunct to neuroendovascular procedures both to prevent and treat ischemic sequelae. Experience with abciximab in this setting is limited; major bleeding complications, including fatal intracranial hemorrhage (ICH), are of particular concern. We report our multicenter experience with ICH following the administration of abciximab during neuroendovascular procedures. Methods We identified neuroendovascular procedures (including cerebral angiograms, aneurysm coiling procedures, angioplasty/vascular stenting procedures, and emergent revascularization procedures) that used abciximab at Mayo Clinic Hospitals in Rochester, Jacksonville, and Phoenix between November 2000 and April 2009. Cases of periprocedural ICH were identified and pertinent demographic, historical, procedural, radiographic, and laboratory data were collected. Clinical outcome was measured either at death or discharge by the Glasgow Outcome Scale (GOS). Results Abciximab was used in 51 neuroendovascular procedures; 9 cases of ICH were identified. Procedures performed and indications for abciximab use varied. Route of abciximab administration included IV bolus only (n = 4), IA bolus followed by IV infusion (n = 3), IV bolus followed by IV infusion (n = 1), and IV infusion without preceding bolus (n = 1). All but 1 of the patients received concomitant periprocedural antiplatelet, anticoagulant, or thrombolytic agents. Eight of the 9 cases of ICH were detected within 7 h of abciximab administration. ICH pattern varied. Four patients died following ICH. Conclusions Adjunctive use of abciximab to prevent or treat ischemic sequelae during neuroendovascular procedures is associated with a high risk of ICH (18%). We report 9 cases of ICH associated with abciximab administration during neuroendovascular procedures with 44% mortality.

AB - Background Abciximab is being used as an adjunct to neuroendovascular procedures both to prevent and treat ischemic sequelae. Experience with abciximab in this setting is limited; major bleeding complications, including fatal intracranial hemorrhage (ICH), are of particular concern. We report our multicenter experience with ICH following the administration of abciximab during neuroendovascular procedures. Methods We identified neuroendovascular procedures (including cerebral angiograms, aneurysm coiling procedures, angioplasty/vascular stenting procedures, and emergent revascularization procedures) that used abciximab at Mayo Clinic Hospitals in Rochester, Jacksonville, and Phoenix between November 2000 and April 2009. Cases of periprocedural ICH were identified and pertinent demographic, historical, procedural, radiographic, and laboratory data were collected. Clinical outcome was measured either at death or discharge by the Glasgow Outcome Scale (GOS). Results Abciximab was used in 51 neuroendovascular procedures; 9 cases of ICH were identified. Procedures performed and indications for abciximab use varied. Route of abciximab administration included IV bolus only (n = 4), IA bolus followed by IV infusion (n = 3), IV bolus followed by IV infusion (n = 1), and IV infusion without preceding bolus (n = 1). All but 1 of the patients received concomitant periprocedural antiplatelet, anticoagulant, or thrombolytic agents. Eight of the 9 cases of ICH were detected within 7 h of abciximab administration. ICH pattern varied. Four patients died following ICH. Conclusions Adjunctive use of abciximab to prevent or treat ischemic sequelae during neuroendovascular procedures is associated with a high risk of ICH (18%). We report 9 cases of ICH associated with abciximab administration during neuroendovascular procedures with 44% mortality.

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KW - Neuroendovascular

KW - Neurointervention

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