Prophylactic Intra-Arterial Eptifibatide in Stent-Assisted Coiling and Flow Diverter Treatment of Cerebral Aneurysms: A Single-Center Retrospective Analysis

Gothelf, Itamar; Epstein, Maor; Shiloh, Adi; Lebowitz, Zachary; Zlotnik, Yair; Sacho, Raphael Hillel; Mechnik Steen, Yana; Ben-Arie, Gal; Horev, Anat

doi:10.3390/jcm14217733

Open AccessArticle

Prophylactic Intra-Arterial Eptifibatide in Stent-Assisted Coiling and Flow Diverter Treatment of Cerebral Aneurysms: A Single-Center Retrospective Analysis

by

Itamar Gothelf

^1,*,†,

Maor Epstein

^2,†

,

Adi Shiloh

¹,

Zachary Lebowitz

²,

Yair Zlotnik

³

,

Raphael Hillel Sacho

⁴,

Yana Mechnik Steen

³,

Gal Ben-Arie

⁵

and

Anat Horev

^3,*

¹

Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel

²

Medical School for International Health, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel

³

Department of Neurology, Soroka University Medical Center, Beer-Sheva 8410101, Israel

⁴

Staten Island University Hospital, New York, NY 10304, USA

⁵

Department of Radiology, Soroka University Medical Center, Beer-Sheva 8410101, Israel

^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2025, 14(21), 7733; https://doi.org/10.3390/jcm14217733

Submission received: 8 September 2025 / Revised: 14 October 2025 / Accepted: 28 October 2025 / Published: 31 October 2025

(This article belongs to the Special Issue Cerebrovascular Disease: Symptoms, Diagnosis and Current Treatment)

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Abstract

Objective: Stent-assisted treatments for intracranial aneurysms, including stent-assisted coiling (SAC) and flow diversion (FD), are associated with an increased thrombotic risk despite dual antiplatelet therapy (DAPT). Recently, intravenous prophylactic protocols incorporating glycoprotein IIb/IIIa antagonists, adapted from cardiology practices, have been introduced. This study evaluates the safety and efficacy of prophylactic low-dose intra-arterial Eptifibatide for cerebral aneurysm management using SAC or FD. Methods: This single-center, single-arm, retrospective study included 99 patients who underwent endovascular treatment with stent-assisted coiling (SAC) or flow diversion (FD) between 2017 and 2023. All patients were initiated on dual antiplatelet therapy (DAPT) 7 days prior to the procedure. Prophylactic intra-arterial Eptifibatide (2–3 mg) was administered intra-procedurally, immediately after stent deployment. Complications were recorded and categorized as periprocedural (occurring during or within 24 h of the procedure) or postprocedural (occurring between 24 and 72 h after the procedure), and included both thrombotic and hemorrhagic events. Results: Among the 99 patients (mean age 57.0 ± 10.8 years), periprocedural complications included three cases of ischemic-related neurological deficits, with no evidence of stent thrombosis or intracranial branch occlusion. All deficits were resolved within 48 h. An additional two patients developed ischemic-related neurological deficits post-procedural. One patient fully recovered following a short rehabilitation period, while the other was left with mild permanent deficits. Overall, any complications following Eptifibatide administration were observed in 5.1% of patients. No hemorrhagic complications were recorded. Conclusions: Prophylactic low-dose intra-arterial Eptifibatide demonstrated a favorable safety profile, potentially reducing thrombotic complications without substantially increasing hemorrhagic risk.

Keywords: intracranial aneurysm; endovascular treatment; stent-assisted coiling; flow-diversion; eptifibatide

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MDPI and ACS Style

Gothelf, I.; Epstein, M.; Shiloh, A.; Lebowitz, Z.; Zlotnik, Y.; Sacho, R.H.; Mechnik Steen, Y.; Ben-Arie, G.; Horev, A. Prophylactic Intra-Arterial Eptifibatide in Stent-Assisted Coiling and Flow Diverter Treatment of Cerebral Aneurysms: A Single-Center Retrospective Analysis. J. Clin. Med. 2025, 14, 7733. https://doi.org/10.3390/jcm14217733

AMA Style

Gothelf I, Epstein M, Shiloh A, Lebowitz Z, Zlotnik Y, Sacho RH, Mechnik Steen Y, Ben-Arie G, Horev A. Prophylactic Intra-Arterial Eptifibatide in Stent-Assisted Coiling and Flow Diverter Treatment of Cerebral Aneurysms: A Single-Center Retrospective Analysis. Journal of Clinical Medicine. 2025; 14(21):7733. https://doi.org/10.3390/jcm14217733

Chicago/Turabian Style

Gothelf, Itamar, Maor Epstein, Adi Shiloh, Zachary Lebowitz, Yair Zlotnik, Raphael Hillel Sacho, Yana Mechnik Steen, Gal Ben-Arie, and Anat Horev. 2025. "Prophylactic Intra-Arterial Eptifibatide in Stent-Assisted Coiling and Flow Diverter Treatment of Cerebral Aneurysms: A Single-Center Retrospective Analysis" Journal of Clinical Medicine 14, no. 21: 7733. https://doi.org/10.3390/jcm14217733

APA Style

Gothelf, I., Epstein, M., Shiloh, A., Lebowitz, Z., Zlotnik, Y., Sacho, R. H., Mechnik Steen, Y., Ben-Arie, G., & Horev, A. (2025). Prophylactic Intra-Arterial Eptifibatide in Stent-Assisted Coiling and Flow Diverter Treatment of Cerebral Aneurysms: A Single-Center Retrospective Analysis. Journal of Clinical Medicine, 14(21), 7733. https://doi.org/10.3390/jcm14217733

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Prophylactic Intra-Arterial Eptifibatide in Stent-Assisted Coiling and Flow Diverter Treatment of Cerebral Aneurysms: A Single-Center Retrospective Analysis

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