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Intravenous cangrelor and oral ticagrelor as an alternative to clopidogrel in acute intervention
  1. Italo Linfante1,2,
  2. Kaushik Ravipati3,
  3. Amy Kathryn Starosciak2,3,
  4. Dennys Reyes1,2,
  5. Guilherme Dabus1,2
  1. 1 Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
  2. 2 Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida, USA
  3. 3 Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Italo Linfante, Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL 33176, USA; linfante.italo{at}


Background Dual antiplatelet therapy (DAP) is necessary to prevent thromboembolic events during carotid stenting, stent-assisted coil embolization, and implant of flow diverters (FD). However, DAP in the acute phase may be challenging. An intravenous alternative, cangrelor, has rapid onset, short plasma half-life, and more reliable antiplatelet action for acute interventions. The study objective was to evaluate feasibility and safety of IV cangrelor during acute neuroendovascular surgery procedures.

Methods We performed a retrospective analysis of our database of patients treated with stent-assisted coil embolization, FD placement for aneurysmal subarachnoid hemorrhage (aSAH), or stenting for acute internal carotid artery (ICA) occlusion where IV cangrelor was used. Morbidity, mortality, incidence of thromboembolic events, hemorrhages, and 90-day outcomes were reported.

Results Ten patients were found in our database from June 2018 through January 2019. Four patients had aSAH, four had middle cerebral artery strokes with tandem lesions, one had an ICA occlusion, and one had a vertebral artery aneurysm. One of the ten patients experienced a thrombotic event. One patient developed new post-procedural bleeding and two had worsening intracranial hemorrhage. Five patients were discharged home in stable condition, two to acute rehabilitation, one to a nursing facility, and two others expired (likely the result of the severe and evolving strokes). Of the eight who were discharged, six (75%) had a good 90-day functional outcome (modified Rankin Scale 0–2).

Conclusion Acute administration of IV cangrelor with or without oral ticagrelor is a feasible antiplatelet treatment option for acute neuroendovascular procedures.

  • stroke
  • thrombectomy
  • stent
  • flow diverter
  • aneurysm

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  • Contributors IL and GD conceptualized the retrospective case review and provided data. AKS and KR reviewed the cases and drafted the manuscript. All authors reviewed and contributed to interpretation of data, revised the manuscript, approved the final version for publication, and agree to be accountable for all aspects of the work.

  • 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.

  • Competing interests IL discloses that he is a proctor, consultant, and speaker for Medtronic, he is a consultant and speaker for Stryker, and holds stock in InNeuroCo, and Three Rivers, outside the submitted work. GD discloses that he is a consultant, proctor, and speaker for Medtronic, is a consultant and speaker for Microvention and Penumbra, is a consultant for Cerenovus, and a shareholder for Surpass, outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Baptist Health South Florida Institutional Review Board (10-060). This was a retrospective review of cases, and a waiver of consent was obtained. Patients did provide informed consent for the standard care medical procedures.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.