Catheter-directed intra-arterial abciximab administration for acute thrombotic occlusions during neurointerventional procedures

Abciximab is one of a new class of platelet aggregation inhibitors that has to date been used mainly in the management of acute coronary ischaemic syndromes or during cardiac intervention for the prevention and treatment of acute vessel occlusion during and after angioplasty or stent placement. More recently, it has begun to play a similar role in neurointerventional work. Its administration during acute stent or vessel occlusions has usually been via systemic intravenous infusion. We describe five cases of acute vessel occlusion during neurointerventional procedures where the abciximab bolus was administered intra-arterially at or close to the site of the occlusion, with rapid complete visual dissolution of the thrombus in four cases and partial dissolution in one, resulting in two patients with no neurological deficits, one with no further neurological deterioration, one with a mild residual thumb paresis and one with a severe neurological deficit.