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- W3183914735 abstract "<h3>Background</h3> Prophylactic carotid artery stenting (CAS) is an effective strategy to reduce perioperative stroke in patients with severe carotid stenosis who require cardiothoracic surgery (CTS). Staging both procedures (CAS-CTS) during a single hospitalization presents conflicting demands for antiplatelet therapy and the optimal pharmacologic strategy between procedures is not established. Eptifibatide (Integrellin), a parenteral GP IIb/IIIa antiplatelet agent with a half-life of 2.5 hours, is an appealing alternative to oral thienopyridines, enabling rapid reversal prior to sternotomy. The purpose of this study is to present our initial experience with a “bridging” eptifibatide protocol for staged CAS-CTS. <h3>Methods</h3> A retrospective review of staged CAS-CTS procedures at a single referral center was performed. All patients had multivessel coronary and/or valvular disease and severe carotid stenosis (>70%) confirmed during preoperative risk assessment. Per the institutional protocol (figure 1), all patients not previously on aspirin were also started on aspirin prior to surgery, followed by eptifibatide during CAS (intraprocedural bolus followed by post-procedural infusion which was continued until the morning of surgery). Pre- and perioperative (30 days) neurologic morbidity and mortality was the primary endpoint. <h3>Results</h3> 11 CAS procedures were performed in ten patients using the protocol. The median duration of eptifibatide bridge therapy was 36 hours (range 24-288hrs). There was one minor bleeding complication (1/11, 9.1%) and no major bleeding complications during the bridging and post-operative period. There was one post-operative, non-neurologic death and zero perioperative ischemic strokes. <h3>Conclusions</h3> For patients undergoing staged CAS-CTS, Eptifibatide bridging therapy is a viable temporary antiplatelet strategy with a favorable safety profile. This strategy enables a flexible range of time-intervals between procedures. <h3>Disclosures</h3> <b>M. Caton:</b> None. <b>K. Narsinh:</b> None. <b>A. Baker:</b> None. <b>J. Rapp:</b> None. <b>W. Gasper:</b> None. <b>J. Iannuzzi:</b> None. <b>E. Tseng:</b> None. <b>M. Amans:</b> None. <b>S. Hetts:</b> None. <b>D. Cooke:</b> None." @default.
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- W3183914735 date "2021-07-26" @default.
- W3183914735 modified "2023-09-25" @default.
- W3183914735 title "E-059 Eptifibatide bridging therapy for staged carotid artery stenting and cardiac surgery" @default.
- W3183914735 doi "https://doi.org/10.1136/neurintsurg-2021-snis.154" @default.
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