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Cangrelor and Stenting in Acute Ischemic Stroke

Monocentric Case Series

  • Original Article
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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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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Frédéric Clarençon.

Ethics declarations

Conflict of interest

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.

Ethical standards

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

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