Administration of eptifibatide during endovascular treatment of ruptured cerebral aneurysms reduces the rate of thromboembolic events

Jacques Sedat (1) , Yves Chau (1) , Jean Gaudard (2) , Laurent Suissa (3) , Sylvain Lachaud (3) , Michel Lonjon (4)

1 Unité de NeuroInterventionnelle
2 SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
3 Unité de NeuroVasculaire
4 unité de neurochirurgie

Introduction Thromboembolic complications are the most frequent complications of endovascular treatment of ruptured intracranial aneurysms. The optimal protocol to prevent thromboembolic complications during coil embolization does not yet exist. The aim of this study was to investigate the effectiveness and safety of eptifibatide for the prevention of thromboembolic complications during elective coil emboliza-tion of ruptured cerebral aneurysms. Methods A consecutive series of 100 patients (group 1) with ruptured intracranial aneurysm were treated using endovascular coil embolization. At the beginning of the procedure , all patients received an intra-arterial bolus (0.2 mg/kg) of eptifibatide. The following data were collected: degree of aneurysmal occlusion after treatment, thromboembolic and hemorrhagic complications and other intraoperative adverse events. The results were compared with those from a control group (group 2) which were analyzed retrospectively. Group 2 consisted of 100 previous patients with ruptured aneurysm managed with coil embolization who had received heparin and/or aspirin at the beginning of the procedure. Results (1) Patient populations in groups 1 and 2 were considered statistically comparable, except that group 1 (eptifibatide) included more wide-necked aneurysms (p=0.011). (2) There were less thromboembolic complications in group 1 (p=0.011): seven intraoperative complications in group 1 versus 20 in group 2. (3) Intraoperative hemorrhagic complications were statistically comparable in both groups (p=1). Conclusion Eptifibatide was effective in lowering the intra-operative thromboembolic complication rate in ruptured an-eurysms treated with coil embolization and did not increase the hemorrhagic risk.

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Jacques Sedat, Yves Chau, Jean Gaudard, Laurent Suissa, Sylvain Lachaud, et al.. Administration of eptifibatide during endovascular treatment of ruptured cerebral aneurysms reduces the rate of thromboembolic events. Neuroradiology, 2015, ⟨10.1007/s00234-014-1452-x⟩. ⟨hal-01310340⟩