Effectiveness of Intra-arterially Administered Abciximab as a Rescue Method for Intracranial Acute In-Stent Thrombosis

ABSTRACT

PURPOSE: To determine the efficacy and safety of the intra-arterial administration of glycoprotein IIb/IIIa inhibitor for resolving acute in-stent thrombosis complicating stent-assisted angioplasty for intracranial atherosclerosis. MATERIALS AND METHODS: We placed 60 therapeutic stents (24 internal carotid arteries, 20 vertebrobasilar arteries, and 16 middle cerebral arteries) for the treatment of symptomatic intracranial atherosclerosis. Among the 60 stenting procedures, acute in-stent thrombosis occurred after stent deployment in 11 cases (18.3%). As the method of dissolving the acute in-stent thrombosis, 2 mg abciximab were intra-arterially administered through a guiding catheter. Angiography was then performed after 10-20 minutes to identify any undissolved material resulting from the thrombosis. If the thrombosis was still observed on the angiography, an additional 2 mg of abciximab were administered, and this procedure was repeated until complete thrombolysis was obtained. Post-procedural non-enhanced brain CT was performed for the evaluation of possible hemorrhagic complications. RESULTS:After each intra-arterial administration of 2 mg of abciximab, successive angiographies showed the process of resolution of the acute thrombosis. All 11 acute in-stent thromboses were completely dissolved within 40 to 80 minutes. The total dosage of infused abciximab was 8 mg in one case, 10 mg in eight cases, and 16 mg in two cases. Post-procedural non-enhanced brain CT revealed no hemorrhagic complications. CONCLUSION: The intra-arterial administration of abciximab can be a safe and effective therapeutic method for acute in-stent thrombosis complicating the stenting of stenotic intracranial arteries.