Abciximab reduces monocyte tissue factor in carotid angioplasty and stenting

Background and Purpose - Abciximab, a nonselective glycoprotein IIb/IIIa inhibitor, was shown to reduce periinterventional stroke rate in carotid stenting. We evaluated the effect of adjunct abciximab therapy on monocyte-platelet cross talk and neurological deficit in unprotected carotid stenting and compared its efficacy with distal filter protection. Methods - Fifty patients were randomized to either standard antithrombotic therapy ( n = 30) consisting of aspirin, clopidogrel, and heparin or adjunct bolus (0.25 mg/kg) and 12-hour infusion (0.125 mug . kg(-1) . min(-1)) of abciximab ( n = 20). A third cohort of patients was stented with filter protection ( n = 30). Monocyte- platelet aggregate formation and monocyte tissue factor expression were determined by whole blood flow cytometry, and F1.2 generation and soluble CD40 ligand (sCD40L) were determined by immunoassay. Results - The incidence of peri-interventional ischemic episodes (23% versus 10%; P = 0.2) and the number of de novo ischemic lesions detected by diffusion-weighted MRI (47% versus 30%; P = 0.17) were not significantly different between standard antithrombotic therapy and adjunct abciximab but were reduced with filter protection ( P = 0.023). However, the number of transient ischemic attacks was lower ( P = 0.05) and the National Institutes of Health Stroke Score rapidly decreased in patients with adjunct abciximab. This clinical improvement was paralleled by a reduction in the postinterventional percentage of activated monocyte-platelet aggregates (CD62P + CD14+; P = 0.018) and the number of tissue factor-positive monocytes (TF+/ CD14+; P = 0.005). Both abciximab and filter protection suppressed F1.2 generation and significantly reduced sCD40L. Conclusions - Abciximab limits thrombus propagation and thrombus stabilization after carotid stenting by reducing monocyte-platelet cross talk and sCD40L. Although abciximab seems inferior to filter devices in peri-interventional cerebral protection, it may be considered in patients who do not allow placement of protection devices.