Cangrelor and Stenting in Acute Ischemic Stroke

• Published in: Clinical neuroradiology (Munich) Vol. 31; no. 2; pp. 439 - 448
• Main Authors: Elhorany, Mahmoud, Lenck, Stephanie, Degos, Vincent, Sourour, Nader-Antoine, Frasca Polara, Giulia, Shotar, Eimad, Godier, Anne
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-06-2021; Springer Nature B.V
• Subjects: Aggregation; Blood platelets; Ischemia; Patients; Stent (Surgery); Stroke; Stroke (Disease)
• ISSN: 1869-1439; 1869-1447
• DOI: 10.1007/s00062-020-00907-0

Purpose Cangrelor is an intravenous P2Y12 receptor inhibitor with a rapid onset/offset of action and a short half-life (3-6â¯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 [greater than or equal to]2b. Good clinical outcome, defined as modified Rankin scale score [less than or equal to]2 at 3âmonths 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.