Thromboelastography detects inadequate response to abciximab therapy during stent-assisted cerebral aneurysm coil embolization complicated by stroke

Neurocrit Care. 2006;4(1):32-4. doi: 10.1385/NCC:4:1:032.


Introduction: Thromboembolic stroke is the most common severe complication following coil embolization of intracerebral aneurysms, with a 5% incidence of permanent deficits. Despite heparin anticoagulation, rescue therapy with the platelet glycoprotein IIb/IIIa receptor antagonist abciximab may be required. However, we describe a failure of abciximab rescue therapy and discuss the importance of monitoring the variable individual response to abciximab.

Case reports: Two patients underwent stent-assisted cerebral aneurysm coil embolization complicated by thromboembolic stroke. In one patient, abciximab rescue therapy failed and was associated with a poor neurological outcome. Thromboelastography (TEG model 5000; Haemoscope, Skokie, IL) and platelet aggregometry suggested inadequate platelet inhibition, although other tests of platelet function suggested adequate inhibition.

Conclusion: We describe a failure of regular-dose abciximab rescue therapy for thromboembolic stroke-complicating stent-assisted cerebral aneurysm coil embolization. The use of TEG to individualize abciximab dosing in this setting may improve patient outcome, as it tracks a pattern of coagulation consistent with the clinical picture.

Publication types

  • Case Reports

MeSH terms

  • Abciximab
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal / therapeutic use*
  • Embolization, Therapeutic*
  • Female
  • Humans
  • Immunoglobulin Fab Fragments / therapeutic use*
  • Intracranial Aneurysm / blood
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / therapy*
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Stents*
  • Stroke / blood
  • Stroke / etiology
  • Thrombelastography*
  • Treatment Failure


  • Antibodies, Monoclonal
  • Immunoglobulin Fab Fragments
  • Platelet Aggregation Inhibitors
  • Abciximab