Initial experience of platelet glycoprotein IIb/IIIa inhibition with abciximab during carotid stenting: A safe and effective adjunctive therapy

Background and Purpose-Abciximab has been shown to decrease periprocedural ischemic complications after coronary intervention. However, the adjunctive use of abciximab in carotid stenting has not been adequately studied. We s ought to determine the efficacy and safety of abciximab in carotid stenting . Methods-Carotid stenting was performed in 151 consecutive patients determin ed to be at high surgical risk by a vascular surgeon. Of these, 128 consecu tive patients received adjuvant therapy with abciximab (0.25 mg/kg bolus be fore the lesion was crossed with guidewire and 0.125 mug (.) kg(-1) (.) min (-1) infusion for 12 hours.). A heparin bolus of 50 U/kg was given, and act ivated clotting time was maintained between 250 to 300 seconds. All patient s received aspirin and thienopyridine. Procedural and 30-day outcomes were compared between the control (n=23) and abciximab (n=128) groups. Results-The 2 groups had similar baseline characteristics. Procedural event s were more frequent in the control group (8%; 1 major stroke and 1 neurolo gical death) compared with the abciximab group (1.6%; 1 minor stroke and 1 retinal infarction; P=0.05). On 30-day follow-up, 1 patient presented with delayed intracranial hemorrhage in the abciximab group. There were no other major bleeding complications. Conclusions-Adjunctive use of abciximab for carotid stenting is safe with n o increase in the risk of intracranial hemorrhage. This adjunctive therapy with potent glycoprotein IIb/IIIa inhibition may help to reduce periprocedu ral adverse events in patients undergoing carotid stenting.