Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms: A meta-Analysis

Waleed Brinjikji, S. F. Morales-Valero, Mohammad H Murad, H. J. Cloft, David F Kallmes

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background and Purpose: Intraprocedural thrombus formation during endovascular treatment of intracranial aneurysms is often treated with glycoprotein IIb/IIIa inhibitors and, in some instances, fibrinolytic therapy. We performed a meta-analysis evaluating the safety and efficacy of GP IIb/IIIa inhibitors compared with fibrinolysis. We also evaluated the safety and efficacy of abciximab, an irreversible inhibitor, compared with tirofiban and eptifibatide, reversible inhibitors of platelet function. Materials and Methods: We performed a comprehensive literature search for studies on rescue therapy for intraprocedural thromboembolic complications with glycoprotein IIb/IIIa inhibitors or fibrinolysis during endovascular treatment of intracranial aneurysms. We studied rates of periprocedural stroke/hemorrhage, procedure-related morbidity and mortality, immediate arterial recanalization, and long-term good clinical outcome. Event rates were pooled across studies by using random-effects meta-analysis. RESULTS: Twenty-three studies with 516 patients were included. Patients receiving GP IIb/IIIa inhibitors had significantly lower perioperative morbidity from stroke/hemorrhage compared with those treated with fibrinolytics (11.0%; 95% CI, 7.0%-16.0% versus 29.0%; 95% CI, 13.0%-55.0%; P = .04) and were significantly less likely to have long-term morbidity (16.0%; 95% CI, 11.0%-21.0% versus 35.0%; 95% CI, 17.0%-58.0%; P=.04). There was a trend toward higher recanalization rates among patients treated with glycoprotein IIb/IIIa inhibitors compared with those treated with fibrinolytics (72.0%; 95% CI, 64.0%-78.0% versus 50.0%; 95% CI, 28.0%-73.0%; P = .08). Patients receiving tirofiban or eptifibatide had significantly higher recanalization rates compared with those treated with abciximab (83.0%; 95% CI, 68.0%-91.0% versus 66.0%; 95% CI, 58.0%-74.0%; P = .05). No difference in recanalization was seen in patients receiving intra-arterial (77.0%; 95% CI, 66.0%- 85.0%) or intravenous GP IIb/IIIa inhibitors (70.0%; 95% CI, 57.0%-80.0%, P = .36). CONCLUSIONS: Rescue therapy with thrombolytic agents resulted in significantly more morbidity than rescue therapy with glycoprotein IIb/IIIa inhibitors. Tirofiban/eptifibatide resulted in significantly higher recanalization rates compared with abciximab.

Original languageEnglish (US)
Pages (from-to)121-125
Number of pages5
JournalAmerican Journal of Neuroradiology
Volume36
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

tirofiban
Intracranial Aneurysm
Platelet Glycoprotein GPIIb-IIIa Complex
Meta-Analysis
Platelet Membrane Glycoprotein IIb
Morbidity
Fibrinolysis
Stroke
Hemorrhage
Therapeutics
Safety
Fibrinolytic Agents
Platelet Aggregation Inhibitors
Thrombolytic Therapy
Thrombosis
Mortality
eptifibatide
abciximab

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

Cite this

Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms : A meta-Analysis. / Brinjikji, Waleed; Morales-Valero, S. F.; Murad, Mohammad H; Cloft, H. J.; Kallmes, David F.

In: American Journal of Neuroradiology, Vol. 36, No. 1, 01.01.2015, p. 121-125.

Research output: Contribution to journalArticle

@article{06c551e55dc842af9bfdf6e7aeba7f62,
title = "Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms: A meta-Analysis",
abstract = "Background and Purpose: Intraprocedural thrombus formation during endovascular treatment of intracranial aneurysms is often treated with glycoprotein IIb/IIIa inhibitors and, in some instances, fibrinolytic therapy. We performed a meta-analysis evaluating the safety and efficacy of GP IIb/IIIa inhibitors compared with fibrinolysis. We also evaluated the safety and efficacy of abciximab, an irreversible inhibitor, compared with tirofiban and eptifibatide, reversible inhibitors of platelet function. Materials and Methods: We performed a comprehensive literature search for studies on rescue therapy for intraprocedural thromboembolic complications with glycoprotein IIb/IIIa inhibitors or fibrinolysis during endovascular treatment of intracranial aneurysms. We studied rates of periprocedural stroke/hemorrhage, procedure-related morbidity and mortality, immediate arterial recanalization, and long-term good clinical outcome. Event rates were pooled across studies by using random-effects meta-analysis. RESULTS: Twenty-three studies with 516 patients were included. Patients receiving GP IIb/IIIa inhibitors had significantly lower perioperative morbidity from stroke/hemorrhage compared with those treated with fibrinolytics (11.0{\%}; 95{\%} CI, 7.0{\%}-16.0{\%} versus 29.0{\%}; 95{\%} CI, 13.0{\%}-55.0{\%}; P = .04) and were significantly less likely to have long-term morbidity (16.0{\%}; 95{\%} CI, 11.0{\%}-21.0{\%} versus 35.0{\%}; 95{\%} CI, 17.0{\%}-58.0{\%}; P=.04). There was a trend toward higher recanalization rates among patients treated with glycoprotein IIb/IIIa inhibitors compared with those treated with fibrinolytics (72.0{\%}; 95{\%} CI, 64.0{\%}-78.0{\%} versus 50.0{\%}; 95{\%} CI, 28.0{\%}-73.0{\%}; P = .08). Patients receiving tirofiban or eptifibatide had significantly higher recanalization rates compared with those treated with abciximab (83.0{\%}; 95{\%} CI, 68.0{\%}-91.0{\%} versus 66.0{\%}; 95{\%} CI, 58.0{\%}-74.0{\%}; P = .05). No difference in recanalization was seen in patients receiving intra-arterial (77.0{\%}; 95{\%} CI, 66.0{\%}- 85.0{\%}) or intravenous GP IIb/IIIa inhibitors (70.0{\%}; 95{\%} CI, 57.0{\%}-80.0{\%}, P = .36). CONCLUSIONS: Rescue therapy with thrombolytic agents resulted in significantly more morbidity than rescue therapy with glycoprotein IIb/IIIa inhibitors. Tirofiban/eptifibatide resulted in significantly higher recanalization rates compared with abciximab.",
author = "Waleed Brinjikji and Morales-Valero, {S. F.} and Murad, {Mohammad H} and Cloft, {H. J.} and Kallmes, {David F}",
year = "2015",
month = "1",
day = "1",
doi = "10.3174/ajnr.A4066",
language = "English (US)",
volume = "36",
pages = "121--125",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
publisher = "American Society of Neuroradiology",
number = "1",

}

TY - JOUR

T1 - Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms

T2 - A meta-Analysis

AU - Brinjikji, Waleed

AU - Morales-Valero, S. F.

AU - Murad, Mohammad H

AU - Cloft, H. J.

AU - Kallmes, David F

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background and Purpose: Intraprocedural thrombus formation during endovascular treatment of intracranial aneurysms is often treated with glycoprotein IIb/IIIa inhibitors and, in some instances, fibrinolytic therapy. We performed a meta-analysis evaluating the safety and efficacy of GP IIb/IIIa inhibitors compared with fibrinolysis. We also evaluated the safety and efficacy of abciximab, an irreversible inhibitor, compared with tirofiban and eptifibatide, reversible inhibitors of platelet function. Materials and Methods: We performed a comprehensive literature search for studies on rescue therapy for intraprocedural thromboembolic complications with glycoprotein IIb/IIIa inhibitors or fibrinolysis during endovascular treatment of intracranial aneurysms. We studied rates of periprocedural stroke/hemorrhage, procedure-related morbidity and mortality, immediate arterial recanalization, and long-term good clinical outcome. Event rates were pooled across studies by using random-effects meta-analysis. RESULTS: Twenty-three studies with 516 patients were included. Patients receiving GP IIb/IIIa inhibitors had significantly lower perioperative morbidity from stroke/hemorrhage compared with those treated with fibrinolytics (11.0%; 95% CI, 7.0%-16.0% versus 29.0%; 95% CI, 13.0%-55.0%; P = .04) and were significantly less likely to have long-term morbidity (16.0%; 95% CI, 11.0%-21.0% versus 35.0%; 95% CI, 17.0%-58.0%; P=.04). There was a trend toward higher recanalization rates among patients treated with glycoprotein IIb/IIIa inhibitors compared with those treated with fibrinolytics (72.0%; 95% CI, 64.0%-78.0% versus 50.0%; 95% CI, 28.0%-73.0%; P = .08). Patients receiving tirofiban or eptifibatide had significantly higher recanalization rates compared with those treated with abciximab (83.0%; 95% CI, 68.0%-91.0% versus 66.0%; 95% CI, 58.0%-74.0%; P = .05). No difference in recanalization was seen in patients receiving intra-arterial (77.0%; 95% CI, 66.0%- 85.0%) or intravenous GP IIb/IIIa inhibitors (70.0%; 95% CI, 57.0%-80.0%, P = .36). CONCLUSIONS: Rescue therapy with thrombolytic agents resulted in significantly more morbidity than rescue therapy with glycoprotein IIb/IIIa inhibitors. Tirofiban/eptifibatide resulted in significantly higher recanalization rates compared with abciximab.

AB - Background and Purpose: Intraprocedural thrombus formation during endovascular treatment of intracranial aneurysms is often treated with glycoprotein IIb/IIIa inhibitors and, in some instances, fibrinolytic therapy. We performed a meta-analysis evaluating the safety and efficacy of GP IIb/IIIa inhibitors compared with fibrinolysis. We also evaluated the safety and efficacy of abciximab, an irreversible inhibitor, compared with tirofiban and eptifibatide, reversible inhibitors of platelet function. Materials and Methods: We performed a comprehensive literature search for studies on rescue therapy for intraprocedural thromboembolic complications with glycoprotein IIb/IIIa inhibitors or fibrinolysis during endovascular treatment of intracranial aneurysms. We studied rates of periprocedural stroke/hemorrhage, procedure-related morbidity and mortality, immediate arterial recanalization, and long-term good clinical outcome. Event rates were pooled across studies by using random-effects meta-analysis. RESULTS: Twenty-three studies with 516 patients were included. Patients receiving GP IIb/IIIa inhibitors had significantly lower perioperative morbidity from stroke/hemorrhage compared with those treated with fibrinolytics (11.0%; 95% CI, 7.0%-16.0% versus 29.0%; 95% CI, 13.0%-55.0%; P = .04) and were significantly less likely to have long-term morbidity (16.0%; 95% CI, 11.0%-21.0% versus 35.0%; 95% CI, 17.0%-58.0%; P=.04). There was a trend toward higher recanalization rates among patients treated with glycoprotein IIb/IIIa inhibitors compared with those treated with fibrinolytics (72.0%; 95% CI, 64.0%-78.0% versus 50.0%; 95% CI, 28.0%-73.0%; P = .08). Patients receiving tirofiban or eptifibatide had significantly higher recanalization rates compared with those treated with abciximab (83.0%; 95% CI, 68.0%-91.0% versus 66.0%; 95% CI, 58.0%-74.0%; P = .05). No difference in recanalization was seen in patients receiving intra-arterial (77.0%; 95% CI, 66.0%- 85.0%) or intravenous GP IIb/IIIa inhibitors (70.0%; 95% CI, 57.0%-80.0%, P = .36). CONCLUSIONS: Rescue therapy with thrombolytic agents resulted in significantly more morbidity than rescue therapy with glycoprotein IIb/IIIa inhibitors. Tirofiban/eptifibatide resulted in significantly higher recanalization rates compared with abciximab.

UR - http://www.scopus.com/inward/record.url?scp=84920940517&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84920940517&partnerID=8YFLogxK

U2 - 10.3174/ajnr.A4066

DO - 10.3174/ajnr.A4066

M3 - Article

C2 - 25082819

AN - SCOPUS:84920940517

VL - 36

SP - 121

EP - 125

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

SN - 0195-6108

IS - 1

ER -