• Vasilije Stambolija, Goran Mrak, Marin Lozic, Josip Ljevak, Martina Miklic Bublic, and Miroslav Scap.
• Division of Neuroanesthesia and Neurocritical Care, University Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Center Zagreb, Zagreb, Croatia. Electronic address: vasilije.stambolija@gmail.com.
• World Neurosurg. 2017 Jul 1; 103: 952.e5-952.e9.

BackgroundIn some cases when risk of occlusion of a blood vessel is greater than risk of bleeding when patients undergo urgent or unplanned bypass during neurosurgery, the use of eptifibatide may be an option. We describe 2 patients who underwent arterial bypass in whom eptifibatide was used successfully intraoperatively during neurosurgery for prevention of bypass occlusion.Case DescriptionThe first patient presented with a right middle cerebral artery (MCA) aneurysm with subocclusive stenosis of the M1 branch. After right-sided osteoplastic frontotemporal craniotomy, the MCA bifurcation was exposed with a bifurcational 6-mm aneurysm with a wide neck. Prebifurcation stenosis was found, with yellow calcification of the vessel wall, and postbifurcation calcification was found on the upper M2 branch. Superficial temporal artery-MCA bypass and occlusion of the MCA aneurysm was done. Before the bypass, continuous intravenous infusion of eptifibatide 1 μg/kg/minute was administered. The patient recovered normally without hemorrhage or neurologic deficit. The second patient presented with a left-sided lateral sphenoid wing meningioma. Left-sided frontotemporal craniotomy was performed, and the tumor was completely removed from the arachnoid layer. The temporal M3 branch was invaded by the meningioma. As there was no flow through the invaded segment of the aforementioned artery, termino-terminal M3 arterial anastomosis was done. Continuous intravenous infusion of eptifibatide 1 μg/kg/minute was administered. Indocyanine green angiography showed normal flow through the anastomosis, and the patient recovered normally.ConclusionsFuture studies are needed to test the safety and potential efficacy of eptifibatide in intraoperative settings.Copyright © 2017 Elsevier Inc. All rights reserved.

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