Study Compares the Use of Rescue Therapies During Endovascular Treatment for Cerebral Aneurysms

May 3, 2013—Using a large, multihospital database, investigators sought to evaluate the morbidity and mortality associated with the use of intra-arterial or intravenous thrombolytic agents or glycoprotein IIb/IIIa inhibitors (GPI) to treat acute intraprocedural thrombus formation during endovascular cerebral aneurysm treatment. Waleed Brinjikji, MD, et al recently published the findings online ahead of print in Stroke.

The investigators found that pharmacological rescue therapy was used in 7% to 8% of endovascular coiling procedures for unruptured and ruptured intracranial aneurysms. They concluded that rescue therapy with thrombolytic agents resulted in significantly higher morbidity and mortality rates than rescue therapy with GPI.

As summarized in Stroke, the investigators used the Premier Perspective Database to examine outcomes of patients who underwent endovascular coiling for ruptured and unruptured aneurysms and required rescue therapy (defined as treatment with GPI or fibrinolytic therapy). They compared discharge status, length of stay, and complication rates across three groups: (1) patients receiving GPI only, (2) patients receiving fibrinolytic therapy only, and (3) patients receiving both GPI and fibrinolytics. The investigators used student t-test to compare continuous variables and the Fisher's exact test to compare categorical variables.

The investigators reported that 7% of patients (254/3627) who were treated for unruptured aneurysms received rescue therapy. Compared with patients receiving GPI alone, the fibrinolytics alone group had significantly higher rates of discharge to other institutions, rather than home (37.5% [9/24] vs 7.4% [15/201]; P < .0001).

Additionally, 8% of patients (338/4204) who were treated for ruptured aneurysms received rescue therapy. When compared with patients receiving GPI alone, the fibrinolytics alone group had significantly higher rates of mortality (26% [18/69] vs 14.5% [35/241]; P = .02) and discharge to institutions other than home (59.4% [41/69] vs 36.5% [88/241]; P < .0001), according to the investigators in Stroke.