Yonsei Med J.  2008 Oct;49(5):857-859. 10.3349/ymj.2008.49.5.857.

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

• Song TJ
• Lee KO
• Kim DJ
• Lee KY

• KMID: 2158207
• DOI: http://doi.org/10.3349/ymj.2008.49.5.857

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.

Keyword

Carotid stent; glycoprotein IIb/IIIa receptor blocker; tissue plasminogen activator

MeSH Terms

*Carotid Artery, Internal
Carotid Stenosis/*drug therapy/radiography/surgery
Emergency Treatment
Humans
Infusions, Intra-Arterial
Male
Middle Aged
Stents
Tyrosine/administration & dosage/*analogs & derivatives/therapeutic use

Figure

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  Fig. 1 Initial brain CT angiography shows bilateral internal carotid artery occlusions.

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  Fig. 2 Serial cerebral angiography. (A) The initial angiography reveals severe stenosis of the right cervical ICA. (B) Reocclusion of the right ICA 20 minutes after initial angiography. (C) After intra-arterial tirofiban infusion, the occluded right ICA is recanalized and severe stenosis remains. (D) Final angiography after carotid stent insertion shows no stenosis of the right ICA. ICA, internal carotid artery.

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