Low risk of intracerebral hemorrhage with adjunctive IIb/IIIa inhibitors in Ad Hoc carotid artery stenting

Academic Article

Abstract

  • Objective: We assessed the risk of intracerebral hemorrhage ICH in patients who underwent carotid artery stenting CAS and received glycoprotein IIbIIIa inhibition as adjunctive antiplatelet therapy. Background: Despite smaller studies to the contrary, we report a negligible risk of ICH with adjunctive glycoprotein IIb/IIIa inhibitor use in CAS. Methods: We reviewed 573 consecutive patients who underwent ad hoc CAS at Baptist Medical Center-Princeton, Birmingham, Alabama between August 1999 and August 2009. Of these, 538 patients were administered a glycoprotein IIb/IIIa inhibitor eptifibatide, n=536, abciximab, n=2 as adjunctive antiplatelet therapy. Results: Most patients were asymptomatic with positive atherosclerotic risk factors of hypertension, coronary artery disease, hyperlipidemia, and history of smoking. The overall procedural success rate was 99.3% and an embolic protection device was used in 95.2% of cases. Mean stenosis of primary lesion was 85.6% pre-procedure and 4.8% post-procedure. There was one 0.2% case of intracerebral hemorrhage. The patient was a 70-year-old Caucasian male with 99.9% stenosis of the ipsilateral right internal carotid artery who was symptomatic from multiple recurrent TIAs with a history of multiple ischemic strokes and extensive comorbidities. Antithrombotic therapy consisted of aspirin, clopidogrel, bivalirudin, and adjunctive use of a single bolus of eptifibatide. Approximately 30 minutes post-procedure, a CT showed the patient suffered a massive ipsilateral intracranial hemorrhage. Other complications in the series included death 0.9%, ischemic stroke 1.1%, TIA 0.9%, and access site bleeding 3.0%. Conclusion: Adjunctive use of the glycoprotein IIbIIIa inhibitor eptifibatide in ad hoc CAS does not increase the risk of intracerebral hemorrhage.
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    Author List

  • Milteer HB; Mendelsohn F; Brantley H; Kiessling J; Bourge R
  • Volume

  • 8
  • Issue

  • 12