Background Treatment of acute cerebrovascular pathology, such as acute ischemic stroke or intracranial aneurysms, presents a challenge if an extracranial or intracranial stent is required; immediate platelet inhibition is vital. To date, there is no standardized approach for antiplatelet inhibition in an acute setting.
Objective To report our preliminary experience and lessons learnt using cangrelor in acute neurointervention.
Methods A single-arm pilot study was performed to assess the safety and efficacy of cangrelor plus aspirin for platelet inhibition in patients who require acute stenting in the setting of neuroendovascular treatment.
Results Eight patients were enrolled between October 2017 and August 2018. Median age was 71 years (53–86). Seven patients were treated in an acute setting according to the stroke protocol at our institution, while one patient was treated for a symptomatic, unruptured aneurysm with flow diversion and coiling. At admission, the median National Institutes of Health Stroke Scale score for the patients with stroke was 12.5 (range 2–22.3). Cangrelor was infused and all patients achieved adequate platelet inhibition (<200 PRU (P2Y12 reaction units)). Six of seven patients with ischemic stroke had a carotid stent placed and one had an intracranial stent deployed in the middle cerebral artery. None of the patients experienced intraprocedural thromboembolic complications, intraprocedural in-stent thrombosis, hemorrhagic complications, or stroke within 24 hours after the intervention. The majority of patients (6/8) had a good clinical outcome at discharge (modified Rankin Scale score 0–2).
Conclusions Our findings suggest that cangrelor is a promising alternative in acute stenting for the treatment of cerebrovascular pathology. However, further studies with larger samples are required to accurately elucidate its safety and effectiveness in neuroendovascular procedures.
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PA-S and RAH contributed equally.
Contributors PA-S and RAH were responsible for study concept and design. PA-S, GJA, RS, and MFG contributed to acquisition of the data. All authors were responsible for analysis and interpretation of the data. All authors contributed to drafting of the manuscript. AA, ES, and RAH contributed to critical revision of the manuscript for important intellectual content. All the authors were responsible for administrative, technical, and material support. AA, ES, and RAH contributed to study supervision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. No financial support were received for this study; however a research grant has been made available for a follow-up study by Chiesi USA, Inc.
Competing interests RAH is a consultant for Medtronic, Stryker, Codman, and MicroVention. The remaining authors have nothing to disclose.
Patient consent Obtained.
Ethics approval Baptist Medical Center Institutional Review Board (IRB), #17-64.
Provenance and peer review Not commissioned; externally peer reviewed.
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