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Abciximab (ReoPro) Dosing Strategy for the Management of Acute Intraprocedural Thromboembolic Complications during Pipeline Flow Diversion Treatment of Intracranial Aneurysms.
Interventional Neurology Pub Date : 2018-02-27 , DOI: 10.1159/000486458
Li-Mei Lin 1 , Bowen Jiang 2 , Jessica K Campos 2 , Narlin B Beaty 2 , Matthew T Bender 2 , Rafael J Tamargo 2 , Judy Huang 2 , Geoffrey P Colby 3 , Alexander L Coon 2
Affiliation  

BACKGROUND Flow diversion with the Pipeline embolization device (PED) is an effective neuro-endovascular method and increasingly accepted for the treatment of cerebral aneurysms. Acute in situ thrombosis is a known complication of PED procedures. There is limited experience in the flow diversion literature on the use of abciximab (ReoPro) for the management of acute thrombus formation in PED cases. METHODS Data were collected retrospectively on patients who received intra-arterial (IA) ReoPro with or without subsequent intravenous (IV) infusion during PED flow diversion treatment of intracranial aneurysms. RESULTS A total of 30 cases in patients with a mean age of 56.7 years (range 36-84) and a mean aneurysm size of 8.6 mm (range 2-25) were identified to have intraprocedural thromboembolic complications during PED treatment. IA ReoPro was administered in all cases, with 20 cases receiving increments of 5-mg boluses and 10 cases receiving a 0.125 mg/kg IA bolus (half cardiac dosing). Complete or partial recanalization was achieved in 100% of the cases. IV ReoPro infusion at 0.125 μg/kg/min for 12 h was administered postprocedurally in 22 cases with a residual thrombus. Postprocedurally, 18 patients were transitioned from clopidogrel (Plavix) to prasugrel (Effient). The majority of the cases (23/30; 77%) were discharged home. Periprocedural intracranial hemorrhage was noted in 2 cases (7%) and radiographic infarct was noted in 4 cases (13%), with an overall mortality of 0% at the time of initial discharge. Clinical follow-up was available for 28/30 patients. The average duration of follow-up was 11.7 months, at which time 23/28 (82%) of the patients had a modified Rankin Scale score of 0. CONCLUSIONS IA ReoPro administration is an effective and safe rescue strategy for the management of acute intraprocedural thromboembolic complications during PED treatment. Using a dosing strategy of either 5-mg increments or a 0.125 mg/kg IA bolus (half cardiac dosing) can provide high rates of recanalization with low rates of hemorrhagic complications and long-term morbidity.

中文翻译:

Abciximab (ReoPro) 给药策略用于颅内动脉瘤管道分流治疗期间急性术中血栓栓塞并发症的管理。

背景技术使用管道栓塞装置(PED)进行导流是一种有效的神经血管内方法,并且越来越多地被接受用于脑动脉瘤的治疗。急性原位血栓形成是PED手术的已知并发症。关于使用阿昔单抗 (ReoPro) 治疗 PED 病例急性血栓形成的导流文献中的经验有限。方法 回顾性收集在颅内动脉瘤的 PED 分流治疗期间接受动脉内 (IA) ReoPro 与或未随后静脉内 (IV) 输注的患者的数据。结果 共有 30 例患者在 PED 治疗期间发生术中血栓栓塞并发症,平均年龄 56.7 岁(范围 36-84 岁),平均动脉瘤大小为 8.6 mm(范围 2-25)。在所有病例中均给予 IA ReoPro,其中 20 例接受增量 5 mg 推注,10 例接受 0.125 mg/kg IA 推注(半心脏给药)。100% 的病例实现了完全或部分再通。在 22 例残留血栓的病例中,术后以 0.125 μg/kg/min 的速度静脉输注 ReoPro,持续 12 小时。术后,18 名患者从氯吡格雷 (Plavix) 过渡到普拉格雷 (Effient)。大多数病例(23/30;77%)出院回家。2 例(7%)出现围手术期颅内出血,4 例(13%)出现影像学梗塞,出院时总死亡率为 0%。对 28/30 名患者进行了临床随访。平均随访时间为 11.7 个月,当时 23/28 (82%) 的患者的改良 Rankin 量表评分为 0。 结论 IA ReoPro 给药是治疗 PED 治疗期间急性术中血栓栓塞并发症的有效且安全的抢救策略。使用 5 mg 增量或 0.125 mg/kg IA 推注(半心脏给药)的给药策略可以提供高再通率,同时出血并发症和长期发病率低。
更新日期:2019-11-01
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