Intravenous Eptifibatide in the Management of Thromboembolic Events during Y-Stent-Assisted Coiling of Intracranial Aneurysms

Abstract

Background— Endovascular treatment of intracranial aneurysms can be complicated by thromboembolic events.
Various prophylactic and therapeutic strategies are utilized to prevent and manage these events. Therapeutic doses of
intra-arterial eptifibatide, abciximab, and tirofiban have been used with varying results.
Case Description— Here we present two patients with anterior communicating artery aneurysms treated with
Y-stent-assisted coil placement. In both patients, the procedures were complicated by complete thrombosis of both
the stents as well as the corresponding anterior cerebral arteries. We describe complete resolution of the thrombus
by administration of two intravenous boluses of eptifibatide (180 μg/kg) 10-minute apart followed by continuous
administration of intravenous eptifibatide for 48 hours thereafter (2μg/kg/min). Both patients recovered without any
significant neurological deficit.
Conclusion— Intravenous eptifibatide may be an effective and safe treatment for thromboembolic events follow
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ing Y-stent-assisted coil placement of intracranial aneurysms.