Abstract
Purpose
Cangrelor is an intravenous P2Y12 receptor inhibitor with a rapid onset/offset of action and a short half-life (3–6 min). The objective was to present a preliminary experience regarding the safety and effectiveness using cangrelor, in combination with aspirin, in acute ischemic stroke patients requiring acute stenting.
Material and Methods
Retrospective analysis for patients who underwent stenting (intracranial and/or extracranial) in the setting of acute ischemic stroke with cangrelor and aspirin as antiplatelet therapy.
Results
Cangrelor was used in 12 patients, 4 (33%) with extracranial stenting, 6 (50%) with intracranial stenting and 2 (17%) with combined extracranial and intracranial stenting. The mean age was 67 years (44–88) and 9 patients (75%) were female. The median National Institutes of Health Stroke Score at admission was 15 (IQR: 8–22). Of the patients, six (50%) received intravenous thrombolysis. All patients (100%) obtained modified thrombolysis in cerebral infarction score ≥2b. Good clinical outcome, defined as modified Rankin scale score ≤2 at 3‑months follow-up, was observed in 7 patients (58%). None of the patients experienced intraprocedural thromboembolic complications. Postprocedural stent thrombosis after cessation of cangrelor infusion due to emergency craniotomy surgery to manage malignant cerebral infarction occurred in one patient (8%). Of the patients, two (17%) experienced asymptomatic intracranial hemorrhage (ICH), one patient (8%) experienced symptomatic ICH and one (8%) retroperitoneal hematoma was observed, which was managed conservatively.
Conclusion
Cangrelor might be a safe and effective antiplatelet medication owing to its on/off activity for acute stenting in the setting of acute ischemic stroke. Further investigations through randomized studies with larger samples are necessary.
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Abbreviations
- ADAPT:
-
A direct aspiration first pass technique
- AIS:
-
Acute ischemic stroke
- CT:
-
Computed tomography
- CTA:
-
CT angiography
- DSA:
-
Digital subtraction angiography
- DWI:
-
Diffusion-weighted imaging
- DWI-ASPECTS:
-
Diffusion weighted image – Alberta stroke program early CT score
- ICA:
-
Internal carotid artery
- ICH:
-
Intracranial hemorrhage
- IV:
-
Intravenous
- IVT:
-
Intravenous thrombolysis
- MCA:
-
Middle cerebral artery
- MRI:
-
Magnetic resonance imaging
- mRS:
-
Modified Rankin scale
- MT:
-
Mechanical thrombectomy
- mTICI:
-
Modified thrombolysis in cerebral infarction score
- NIHSS:
-
National Institutes of Health Stroke Score
- PCI:
-
Percutaneous coronary intervention
- PED:
-
Pipeline embolization device
- SAH:
-
Subarachnoid hemorrhage
- TOF:
-
Time of flight
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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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All the co-authors contributed equally to prepare and accomplish this manuscript: Frédéric Clarençon supervised the work and critically reviewed the manuscript Mahmoud Elhorany: was responsible for writing the manuscript with modification upon to the co-author’s revisions and suggestions, and performing the required statistics. Frédéric Clarençon was the final reviewer and coordinator of the resulting work.
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N.-A. Sourour is consultant for Medtronic, Balt Extrusion, Microvention, Stock/Stock Options: Medina. F. Clarençon reports conflict of interest (unrelated) with Medtronic, Guerbet, Balt Extrusion (payment for readings), Artedrone (consultant), Codman Neurovascular and Microvention (core lab). M. Elhorany, S. Lenck, V. Degos, G. Frasca Polara, E. Shotar, A. Godier, M. Drir, J. Mahtout, K. Premat, S. Alamowitch and Y. Samson report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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Ethics approval: this study was approved by the institutional review board (IRB). Consent to participate: The consent was waived by our IRB. Consent for publication: the consent was waived by the IRB.
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Elhorany, M., Lenck, S., Degos, V. et al. Cangrelor and Stenting in Acute Ischemic Stroke. Clin Neuroradiol 31, 439–448 (2021). https://doi.org/10.1007/s00062-020-00907-0
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DOI: https://doi.org/10.1007/s00062-020-00907-0