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Original research
Use of intravenous cangrelor in the treatment of ruptured and unruptured cerebral aneurysms: an updated single-center analysis and pooled analysis of current studies
  1. Pouya Entezami1,
  2. John C Dalfino1,
  3. Alan S Boulos1,
  4. Junichi Yamamoto1,
  5. Devin N Holden2,
  6. Nicholas C Field1,
  7. Andrew K Rock1,
  8. Edinson Najera1,
  9. Alexandra R Paul1
  1. 1Neurosurgery, Albany Medical Center, Albany, New York, USA
  2. 2Department of Pharmacy, Albany Medical Center, Albany, New York, USA
  1. Correspondence to Dr Alexandra R Paul, Department of Neurosurgery, Albany Medical Center, Albany, NY 122088, USA; PaulA1{at}amc.edu

Abstract

Background Intracranial stent placement for the treatment of cerebral aneurysms is increasingly utilized in both ruptured and unruptured scenarios. Intravenous (IV) cangrelor is a relatively new antiplatelet agent that was initially approved for coronary interventions. In addition to our institution, five other centers have published their results using IV cangrelor in neurointerventional procedures. This article combines the aneurysm treatment data from all prior studies to provide insight into the safety and efficacy of cangrelor for intracranial aneurysm treatment.

Methods A prospectively maintained database was reviewed to identify all cases of IV cangrelor administration during aneurysm embolization. 20 additional patients were identified who had not been previously published. In addition, a literature search was performed to identify prior publications regarding cangrelor in neurointervention. The data from these were combined with our institutional results in a pooled-analysis.

Results Overall, 85 patients who received IV cangrelor during aneurysm embolization were identified, including 46 ruptured and 39 unruptured cases. The asymptomatic and symptomatic intracranial hemorrhage rates were 4% (2/46) for ruptured cases and 2.6% (1/39) for unruptured cases. The rate of retroperitoneal hematoma and gastrointestinal bleeding was 0%. There were no incidents of intraprocedural thromboembolic complication or intraprocedural in-stent thrombosis in either cohort. One subject suffered an ischemic stroke at 24 hours secondary to in-stent thrombosis in a ruptured case.

Conclusions IV cangrelor during aneurysm embolization appears to be safe, with a symptomatic intracranial hemorrhage rate of 4% in ruptured cases and 2.6% in unruptured cases. More research is needed to determine the ideal dosing regimen.

  • Stent
  • Aneurysm
  • Subarachnoid
  • Hemorrhage
  • Platelets

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Footnotes

  • Contributors PE helped design data collection tools, perform analysis, create tables, and assisted in initial manuscript writing and revisions. DH, AKR, NCF and EN were involved in data collection, data analysis, manuscript writing, and manuscript revision. JCD, ASB and JY helped with data collection, provided critical analysis and assisted in writing of the manuscript, and were charged with monitoring of data collection. In addition to these roles, AP was the study supervisor, guarantor, and initial developer of the study design. PE, DH, AKR and AP helped perform the literature review and compiling data from other centers.

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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