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  • Efficacy and safety of low dose intravenous cangrelor in a consecutive cohort of patients undergoing neuroendovascular procedures

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New devices and techniques
Original research
Efficacy and safety of low dose intravenous cangrelor in a consecutive cohort of patients undergoing neuroendovascular procedures
  1. Federico Cagnazzo1,
  2. Răzvan Alexandru Radu2,
  3. Imad Derraz3,
  4. Pierre Henri Lefevre4,
  5. Cyril Dargazanli5,
  6. Paolo Machi6,
  7. Riccardo Morganti7,
  8. Gregory Gascou3,
  9. Julien Fendeleur8,
  10. Francesca Rapido8,
  11. Vincent Costalat9
  1. 1 Neuroradiology Department, Hôpital Gui de Chauliac, Montpellier, France
  2. 2 Neuroradiology, Hospital Gui de Chauliac, Montpellier, France
  3. 3 Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
  4. 4 Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
  5. 5 Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
  6. 6 Department of Neuroradiology, University of Geneva, Geneve, Switzerland
  7. 7 Section of Statistics, University Hospital of Pisa, Pisa, Italy
  8. 8 Anaesthesiology and Critical Care Medicine, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
  9. 9 Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
  1. Correspondence to Dr Federico Cagnazzo, Neuroradiology Department, Hôpital Gui de Chauliac, Montpellier, 34295, France; f.cagnazzo86{at}gmail.com

Abstract

Background Cangrelor is an intravenous P2Y12 inhibitor with rapid onset and fast offset of antiplatelet action. Dose adjusted cangrelor based on platelet function testing is suggested to be advantageous for use during neuroendovascular procedures. In this study, we aimed to assess the efficacy and safety of this strategy.

Methods This retrospective study included consecutive patients who received low dose intravenous cangrelor (5 µg/kg; infusion 1 µg/kg/min) for ruptured (RIA) and unruptured (UIA) intracranial aneurysms, and acute ischemic stroke (AIS). Indications were acute stenting or intraluminal thrombus. Outcomes were assessed at 24 hours by brain CT and CT angiography. The primary efficacy outcome was the rate of stent occlusion or persistent intraluminal thrombus. The primary safety outcome was the rate of major hemorrhages.

Results 101 patients (56 men; median age (IQR) 59 (51–70) years) received low dose cangrelor for acute stenting (79/101 (78%)) and intraprocedural thrombus (22/101 (22%)). Overall, 5 (4.9%) patients experienced stent occlusion within 24 hours (RIA 3/28; AIS 2/52). There were no cases of failure among UIA patients. Stent mis-opening (fish mouthing or stenosis >50%) was significantly associated with stent occlusion (P<0.001). The overall rate of major hemorrhage was 2% (2/101), which occurred in AIS patients. Platelet reactivity unit (PRU) values were lower in those presenting with major hemorrhage (PRU 4 (SD 1.4) vs PRU 60 (SD 63); P=0.043). Mortality rate after cangrelor related hemorrhage was 1%.

Conclusions Low dose cangrelor appears to be effective in preventing stent thrombosis and arterial patency with a low hemorrhagic risk.

  • Aneurysm
  • Stroke
  • Stent
  • Pharmacology

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-020094

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Correction notice This article has been corrected since it was published online. Column headings of Table 4 have been updated.

    • Contributors FC is the first author and collected the data and wrote the paper. RAR collected the data. ID, PHL, CD, and GG provided and cared for study patients. PM critically reviewed the study proposal. FR, JF, and VC provided and cared for study patients and critically reviewed the study proposal. RM performed the statistical analysis. FC is the guarantor.

    • 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 None declared.

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