Evaluation of glycoprotein IIb/IIIa inhibitors in carotid angioplasty and stenting

Michael Henry Wholey, Mark Henry Wholey, Gustave Eles, Boulis Toursakissian, Steven R Bailey, Chester Jarmolowski, Walter A. Tan

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Purpose: To review the immediate neurological and bleeding complications associated with the use of glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing extracranial carotid artery stent placement. Methods: A retrospective review was performed of 550 patients (321 men; mean age 71.1 years, range 28-91) who underwent carotid artery angioplasty and stent placement. Glycoprotein IIb/IIIa inhibitors were given prophylactically along with heparin to 216 patients, whose outcomes were compared to a control group of 334 patients who received intravenous heparin alone. Primary endpoints were the immediate and 30-day neurological complications, including transient ischemic attacks (TIAs), minor and major strokes, and neurologically-related deaths. The secondary endpoint was any abnormal bleeding. Results: The all stroke/neurological death rate in 216 patients treated with heparin and GP IIb/IIIa inhibitors was 6.0% (13 events) compared 2.4% (8 events) in the 334 patients in the heparin-only control group (p=0.0430). Two of the 4 neurologically-related deaths in the GP IIb/IIIa inhibitor group resulted from intracranial hemorrhages; there were no intracranial hemorrhages in the heparin-only group. There was 1 episode of extracranial bleeding in the GP IIb/IIIa inhibitor group treated with embolization. The incidences of significant puncture-site bleeding requiring transfusion were similar in the groups. Conclusions: Neurological complications following percutaneous carotid artery interventions have been relatively few. The neurological sequelae in carotid stent patients receiving glycoprotein IIb/IIIa inhibitors were more numerous and consequential, which suggests that the use of GP IIb/IIIa inhibitors in carotid stenting should be discouraged.

Original languageEnglish (US)
Pages (from-to)33-41
Number of pages9
JournalJournal of Endovascular Therapy
Volume10
Issue number1
DOIs
StatePublished - Feb 2003

Fingerprint

Platelet Glycoprotein GPIIb-IIIa Complex
Angioplasty
Heparin
Carotid Arteries
Hemorrhage
Stents
Intracranial Hemorrhages
Stroke
Control Groups
Transient Ischemic Attack
Punctures
Mortality
Incidence

Keywords

  • Bleeding
  • Carotid artery disease
  • Complications
  • Glycoprotein IIb/ IIIa inhibitors
  • Heparin
  • Internal carotid artery
  • Intracranial hemorrhage
  • Mortality
  • Stenosis
  • Stent
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Evaluation of glycoprotein IIb/IIIa inhibitors in carotid angioplasty and stenting. / Wholey, Michael Henry; Wholey, Mark Henry; Eles, Gustave; Toursakissian, Boulis; Bailey, Steven R; Jarmolowski, Chester; Tan, Walter A.

In: Journal of Endovascular Therapy, Vol. 10, No. 1, 02.2003, p. 33-41.

Research output: Contribution to journalArticle

Wholey, Michael Henry ; Wholey, Mark Henry ; Eles, Gustave ; Toursakissian, Boulis ; Bailey, Steven R ; Jarmolowski, Chester ; Tan, Walter A. / Evaluation of glycoprotein IIb/IIIa inhibitors in carotid angioplasty and stenting. In: Journal of Endovascular Therapy. 2003 ; Vol. 10, No. 1. pp. 33-41.
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AU - Eles, Gustave

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AU - Jarmolowski, Chester

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N2 - Purpose: To review the immediate neurological and bleeding complications associated with the use of glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing extracranial carotid artery stent placement. Methods: A retrospective review was performed of 550 patients (321 men; mean age 71.1 years, range 28-91) who underwent carotid artery angioplasty and stent placement. Glycoprotein IIb/IIIa inhibitors were given prophylactically along with heparin to 216 patients, whose outcomes were compared to a control group of 334 patients who received intravenous heparin alone. Primary endpoints were the immediate and 30-day neurological complications, including transient ischemic attacks (TIAs), minor and major strokes, and neurologically-related deaths. The secondary endpoint was any abnormal bleeding. Results: The all stroke/neurological death rate in 216 patients treated with heparin and GP IIb/IIIa inhibitors was 6.0% (13 events) compared 2.4% (8 events) in the 334 patients in the heparin-only control group (p=0.0430). Two of the 4 neurologically-related deaths in the GP IIb/IIIa inhibitor group resulted from intracranial hemorrhages; there were no intracranial hemorrhages in the heparin-only group. There was 1 episode of extracranial bleeding in the GP IIb/IIIa inhibitor group treated with embolization. The incidences of significant puncture-site bleeding requiring transfusion were similar in the groups. Conclusions: Neurological complications following percutaneous carotid artery interventions have been relatively few. The neurological sequelae in carotid stent patients receiving glycoprotein IIb/IIIa inhibitors were more numerous and consequential, which suggests that the use of GP IIb/IIIa inhibitors in carotid stenting should be discouraged.

AB - Purpose: To review the immediate neurological and bleeding complications associated with the use of glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing extracranial carotid artery stent placement. Methods: A retrospective review was performed of 550 patients (321 men; mean age 71.1 years, range 28-91) who underwent carotid artery angioplasty and stent placement. Glycoprotein IIb/IIIa inhibitors were given prophylactically along with heparin to 216 patients, whose outcomes were compared to a control group of 334 patients who received intravenous heparin alone. Primary endpoints were the immediate and 30-day neurological complications, including transient ischemic attacks (TIAs), minor and major strokes, and neurologically-related deaths. The secondary endpoint was any abnormal bleeding. Results: The all stroke/neurological death rate in 216 patients treated with heparin and GP IIb/IIIa inhibitors was 6.0% (13 events) compared 2.4% (8 events) in the 334 patients in the heparin-only control group (p=0.0430). Two of the 4 neurologically-related deaths in the GP IIb/IIIa inhibitor group resulted from intracranial hemorrhages; there were no intracranial hemorrhages in the heparin-only group. There was 1 episode of extracranial bleeding in the GP IIb/IIIa inhibitor group treated with embolization. The incidences of significant puncture-site bleeding requiring transfusion were similar in the groups. Conclusions: Neurological complications following percutaneous carotid artery interventions have been relatively few. The neurological sequelae in carotid stent patients receiving glycoprotein IIb/IIIa inhibitors were more numerous and consequential, which suggests that the use of GP IIb/IIIa inhibitors in carotid stenting should be discouraged.

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KW - Internal carotid artery

KW - Intracranial hemorrhage

KW - Mortality

KW - Stenosis

KW - Stent

KW - Stroke

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