Abstract TP359: Decreased Silent Brain Ischemic Lesions Following Aneurysm Flow Diversion with Intraoperative Eptifibatide: A Retrospective Study and a Meta-Analysis

Introduction: Endovascular treatment of intracranial aneurysms is associated with a risk of thromboembolic complications. Most of these events are clinically silent and identified only on diffusion-weighted imaging (DWI). Glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide) are widely used during percutaneous coronary interventions, but their role in preventing ischemic injury during neurointerventional procedures has not been fully studied. We investigated the incidence of DWI lesions after aneurysm treatment with flow diversion performed using intraoperative eptifibatide rather than dual anti-platelet pre-treatment. Methods: Data were derived form a retrospective analysis of a prospectively maintained cerebrovascular data base. 50 consecutive adult patients with unruptured intracranial aneurysms who were pre-treated with ASA monotherapy and underwent flow-diversion with intraoperative eptifibatide were included. DWI scans were obtained within 72 h after all interventions. Demographic, aneurysmal, procedural, and post-procedural characteristics were analyzed using univariate regression and multivariable Firth's penalized logistic regression (including variables with p mean) fluoroscopy time (OR 15.42, 95% CI 2.64–90.00, p = 0.002), higher (> mean) fluoroscopy dose (OR 6.88, 95% CI 1.35–34.97, p = 0.020), and ASA/Plavix DAPT regimen (OR 9.33, 95% CI 1.05–82.78, p = 0.045) were significantly associated with DWI lesion occurrence. None of the variables was an independent predictor of DWI lesions based on multivariate analysis. The incidence of DWI lesions was 8/50 (16%). No neurological or peripheral hemorrhagic events were observed. Nine studies were included in the meta-analysis. The overall pooled incidence of DWI lesions was 56% (95% CI: 32%–77%). The rate of DWI lesions in our cohort was significantly lower than in the pooled cohort (OR = 0.11, 95% CI = 0.043–0.24, p < 0.001) and seven of the eight individual cohorts (all p≤0.002). Conclusions: Intraoperative eptifibatide may decrease the incidence of DWI lesions during flow diversion procedures without increasing the risk for hemorrhagic complications.