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Safety and Efficacy of Tirofiban in Stent-Assisted Coil Embolization of Intracranial Aneurysms

Chalouhi, Nohra MD*; Jabbour, Pascal MD*; Kung, David MD; Hasan, David MD

doi: 10.1227/NEU.0b013e31826213f9
Research-Human-Clinical Studies

BACKGROUND: Thromboembolic complications are a major concern in stent-assisted coiling of intracranial aneurysms that may be prevented with adequate antiplatelet therapy.

OBJECTIVE: To assess the safety and efficacy of tirofiban in stent-assisted coiling.

METHODS: Two protocols were used. In the initial protocol, tirofiban was administered intravenously as a 0.4 μg/kg per min bolus for 30 minutes followed by 0.10 μg·kg−1 min−1 maintenance infusion. The revised protocol consisted of a 0.10 μg·kg−1 min−1 maintenance infusion alone.

RESULTS: Sixty-seven patients received tirofiban, 16 under the initial protocol 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%) intracranial hemorrhages 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 computed tomographic 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.

ABBREVIATIONS: SAC, stent-assisted coiling

SAH, subarachnoid hemorrhage

*Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania

Department of Neurosurgery, University of Iowa, Iowa City, Iowa

Correspondence: David M. Hasan, MD, Assistant Professor of Neurosurgery, Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242. E-mail:

Received January 23, 2012

Accepted May 16, 2012

Copyright © by the Congress of Neurological Surgeons