Intravenous abciximab for parent vessel thrombus during basilar apex aneurysm coil embolization: case report and literature review

BACKGROUND: Parent vessel thrombus formation is a serious complication of intracranial aneurysm embolization. The management of this issue is controversial. Abciximab, a potent platelet inhibitor, has been shown to have thrombolytic effects during coronary interventions. A small number of cases have demonstrated its potential application in neuroendovascular procedures. We review the literature on the management of parent vessel thrombosis during aneurysm coil embolization and report our successful experience with the use of IV abciximab to treat parent vessel thrombus formation related to coil embolization of a basilar apex aneurysm. CASE DESCRIPTION: A 45-year-old man presented to our center with an incidental basilar apex aneurysm. After being informed of the surgical and endovascular treatment options, he elected to undergo coil embolization of the aneurysm. During the procedure, acute thrombus was noted in the left P1 segment of the posterior cerebral artery. IV abciximab was administered, and an angiogram the following day showed complete dissolution of the clot. The patient had no neurologic sequelae. CONCLUSIONS: IV abciximab appears to be an effective option in the management of acute parent vessel thrombus encountered during coil embolization of unruptured aneurysms. Sufficient data are lacking regarding its use in the setting of a ruptured aneurysm.