Adjunctive use of eptifibatide for complication management during elective neuroendovascular procedures

OBJECTIVE: A rare complication of neuroendovascular procedures is acute thromboembolism. In the setting of intraprocedural or periprocedural embolism, thrombolytics present a potentially useful therapeutic strategy. A series of patients in whom eptifibatide (a platelet glycoprotein IIb/IIIa receptor inhibitor) was used in the treatment of iatrogenic thromboembolic events occurring during elective neuroendovascular procedures is described. METHODS: Consecutive cases between May 2009 and July 2011 in which eptifibatide was administered were identified and individually reviewed for inclusion in this study (n=12). All study patients received a uniform, weight based bolus dose of 180 μg/kg of eptifibatide administered either intra-arterially through the guide catheter or intravenously. Eptifibatide infusion (2 μg/kg/min) for 24 h after bolus dose administration was continued at the discretion of the surgeon. Procedural details are described and illustrative cases presented. RESULTS: Three major categories of thromboembolic events were isolated in the course of review of study cases: acute focal neurological decline and no radiographic findings of flow limitation (eight patients), radiographic findings with or without symptoms (two patients) and persistent particulate debris during flow reversal as part of a carotid revascularization procedure (two patients). Following eptifibatide administration, no patient experienced hemorrhagic complications, and neurologic improvement to baseline level was noted in 10 of 12 patients. CONCLUSION: Eptifibatide may be an effective therapeutic strategy in the event of thromboembolism during elective neuroendovascular procedures.