Intracarotid abciximab injection to abort impending ischemic stroke duringcarotid angioplasty

Background: Abciximab, a platelet glycoprotein IIb/IIIa receptor antagonist , prevents ischemic complications during percutaneous transluminal coronary angioplasty and was recently shown to open occluded vessels in patients wi th acute myocardial infarction when used alone or in combination with other thrombolytic agents. In an animal model of arterial thrombosis, abciximab was found to be safe and effective for the prevention of carotid artery thr ombosis. However, the safety and efficacy of abciximab in the treatment of acute ischemic cerebrovascular events is unknown at present. Case Descripti on: We describe 3 patients who experienced ischemic cerebrovascular events with symptoms involving the middle cerebral artery territory while undergoi ng percutaneous angioplasty and stenting to their internal carotid arteries . Abciximab was administered to each patient within 10 min of symptom onset as a bolus (0.25 mg/kg) into the ipsilateral common carotid artery followe d by continuous intravenous infusion (9 mug/min) for 12 h. All patients' sy mptoms resolved completely (by 25 min, 40 min and 5 h, respectively) with n o further neurological complications. Conclusions: Our preliminary observat ion suggests that abciximab may improve neurological outcome following midd le cerebral artery ischemic events associated with carotid angioplasty and stenting. Large prospective studies are warranted to establish the safety a nd efficacy of abciximab in acute ischemic stroke, either as a primary trea tment modality or an adjunct to carotid angioplasty and stenting, Copyright (C) 2001 S. Karger AG, Basel.