Administration of eptifibatide as rescue therapy during mechanical thrombectomy in acute ischemic stroke

David Černík^1,2*Jiri Neumann³Jarmila Neradova²Veronika Hlinena²Pavol Viglas⁴David Cihlar⁵Filip Cihlar⁴

• ¹Department of Neurology, Univerzita Palackeho v Olomouci Lekarska fakulta, Olomouc, Czechia
• ²Department of Neurology, Masarykova nemocnice Usti nad Labem oz, Ústí nad Labem, Czechia
• ³Krajska zdravotni as Nemocnice Chomutov oz, Chomutov, Czechia
• ⁴Department of Radiology, J. E. Purkinje University, Masarykova nemocnice Usti nad Labem oz, Ústí nad Labem, Czechia
• ⁵Department of Physical Education and Sport Faculty of Education, Univerzita Jana Evangelisty Purkyne v Usti nad Labem, Ústí nad Labem, Czechia

Background: The success of the technical implementation of mechanical thrombectomy (MT) depends on many factors. Considering the experience of the interventional radiologist and the anatomical vascular differences of individual patients, it has technical limits. In our group, we focused on verifying the effectiveness and safety of eptifibatide intra-arterial administration when a sufficient degree of recanalization was not achieved with standard instruments. Methods: The study included 1350 patients who underwent MT between 2008 and 2022. Neurological deficit was assessed with National Institutes of Health Stroke Scale (NIHSS) and clinical outcome with modified Rankin scale (mRS). Presence of symptomatic intracerebral hemorrhage (SICH) was assessed according to the SITS-MOST criteria. In some patients, eptifibatide was administered in the case of insufficient recanalization or in the case of an acute periprocedural tendency to reocclusion. Achieved recanalization using the Thrombolysis in Cerebral Infarction scale (TICI). Results: Eptifibatide was administered during the procedure to 181 patients (age 67.8±12.2 years, 57.5 % men). In the eptifibatide group, successful recanalization (≥TICI2b) was achieved in 80.1 %, the incidence of ICH was 21.6 % and SICH 3.9 %. In the group without eptifibatide, successful recanalization was achieved in 80.5%, ICH 19.9 % and SICH 5.2 %. Conclusions: The use of eptifibatide is an effective and safe procedure in technically more difficult cases of MT. It enables a similar degree of recanalization to be achieved without increasing the risk of SICH.