Rescue Treatment with Intra-arterial Tirofiban Infusion and Emergent Carotid Stenting

다국어 초록 (Multilingual Abstract)

Rapid arterial rethrombosis is associated with high-grade residual stenosis and usually occurs at the site of the initial occlusion, resulting in reocclusion of the recanalized artery. Platelets may play an active role in such rethrombosis after thrombolytic-induced clot lysis. Given that glycoprotein IIb/IIIa receptor blockers, like tirofiban, prevent thrombus formation by inhibiting the final common pathway of platelet aggregation, they may be helpful for treating rethrombosis after thrombolysis. A 64-year-old man presented with an acute ischemic stroke due to internal carotid artery (ICA) occlusion. The ICA was recanalized by intravenous thrombolysis but reoccluded shortly after recanalization. The reoccluded ICA was successfully recanalized using intra-arterial tirofiban. A carotid stent was subsequently inserted to relieve severe stenosis and to prevent recurrent stroke. Here, we report a case of rescue treatment of a successfully recanalized ICA by intra- arterial tirofiban. We suggest that rescue use of intra-arterial tirofiban may be effective and safe, especially in hemorrhage prone situations, due to the relatively lower dose of tirofiban compared with intravenous doses.

참고문헌 (Reference)

1 Liebeskind DS, "Vertebrobasilar thrombolysis with intravenous tirofiban: case report" 13 : 81-84, 2002

2 The EPIC Investigators, "Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty" 330 : 956-961, 1994

3 Seitz RJ, "The effect of combined thrombolysis with rtPA and tirofiban on ischemic brain lesions" 62 : 2110-2112, 2004

4 Straub S, "Systemic thrombolysis with recombinant tissue plasminogen activator and tirofiban in acute middle cerebral artery occlusion" 35 : 705-709, 2004

5 Lee KY, "Rescue treatment with abciximab in acute ischemic stroke" 56 : 1585-1587, 2001

6 Qureshi AI, "Reocclusion of recanalized arteries during intra-arterial thrombolysis for acute ischemic stroke" 25 : 322-328, 2004

7 Ho DS, "Intracarotid abciximab injection to abort impending ischemic stroke during carotid angioplasty" 11 : 300-304, 2001

8 Heo JH, "Immediate reocclusion following a successful thrombolysis in acute stroke: a pilot study" 60 : 1684-1687, 2003

9 Rukshin V, "Effects of GP IIb/IIIa receptor inhibitor tirofiban (aggrastat) in ex vivo canine arteriovenous shunt model of stent thrombosis" 41 : 615-624, 2003

10 Wallace RC, "Basilar artery rethrombosis: successful treatment with platelet glycoprotein IIB/IIA receptor inhibitor" 18 : 1257-1260, 1997

11 Alexandrov AV, "Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator" 59 : 862-867, 2002