Abciximab as an adjunct to high-risk carotid or vertebrobasilar angioplasty: Preliminary experience

OBJECTIVE: Abciximab, a platelet glycoprotein IIb/IIIa receptor inhibitor, has been shown to reduce the risk of ischemic events associated with corona ry intervention. However, its role in neurointerventional procedures needs to be defined. We prospectively evaluated our initial experience with the u se of abciximab in a series of high-risk patients undergoing carotid, basil ar, or vertebral artery angioplasty. METHODS: Patients were given an intravenous abciximab bolus (0.25 mg/kg), f ollowed by infusion (10 mu g/min) for a period ranging from 12 to 24 hours, as an adjunct to angioplasty in 20 procedures (19 patients). These patient s were considered to be at high risk for thromboembolic events because of r ecent ischemic symptoms and/or complex lesion morphology. Before, immediate ly after, and 24 hours after the procedure, each patient was evaluated by a neurologist for the presence of new neurological deficits. Any bleeding or other complications during hospitalization were also recorded. Bleeding wa s defined as major (hemoglobin decrease >5 g/dl), minor (hemoglobin decreas e 3-5 g/dl), or insignificant. RESULTS: Angioplasty was performed in the internal carotid artery (n = 13), vertebral artery (n = 4), or basilar artery (n = 2). Stents were placed ac ross 13 lesions. In one patient, angioplasty could not be performed owing t o technical difficulties; however, abciximab was administered because of ex tensive lesion manipulation. Intraprocedural heparin was given in 19 proced ures (35-86 U/kg intravenously) and partially reversed in 6 procedures. Low -dose intra-arterial thrombolytic agents were administered in seven patient s before the lesion was crossed. Two patients experienced transient neurolo gical deficits either during (n = 1) or immediately after (n = 1) the proce dure. Another patient had complete occlusion of the right vertebral artery after angioplasty with complete recanalization after 24 hours of abciximab infusion. Major or minor bleeding was not observed in any patient. Insignif icant bleeding was observed in eight patients. Thrombocytopenia was observe d in one patient who received concomitant administration of intravenous hep arin and abciximab infusion. CONCLUSION: We observed a low frequency of neurological events in high-risk patients undergoing angioplasty with or without stent placement. Abciximab seems to be a relatively safe adjunct for carotid or vertebrobasilar endov ascular intervention either alone or in combination with low-dose thromboly tics. Partial reversal of intraprocedural heparin should be considered to r educe the risk of postprocedural bleeding.