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The use of cangrelor in neurovascular interventions: a multicenter experience
Gustavo M Cortez1,2, André Monteiro1, Nader Sourour3
1Lyerly Neurosurgery, Baptist Neurological Institute, 800 Prudential drive, Weaver tower, 11th floor, Jacksonville, FL, USA.
Insights
Intravenous cangrelor shows promise as a safe and effective antiplatelet agent for neurovascular interventions, with low complication rates in ischemic and aneurysm cases. This P2Y12-receptor antagonist offers a viable option for urgent procedures.
Area of Science:
- Neuroscience
- Cardiology
- Interventional Neurology
Background:
- Thromboembolic events are a significant risk in neurointerventions.
- Cangrelor, an intravenous P2Y12-receptor antagonist, offers rapid onset and offset for antiplatelet therapy.
Purpose of the Study:
- To evaluate the safety and effectiveness of intravenous cangrelor in patients undergoing neurovascular intervention.
- To assess periprocedural complications and outcomes in ischemic and aneurysm patient groups.
Main Methods:
- Retrospective analysis of 66 patients from four cerebrovascular centers.
- Patients were divided into ischemic and aneurysm groups.
- Analysis of periprocedural thromboembolic and hemorrhagic events, and patient outcomes.
Main Results:
- The ischemic group (n=42) had a 9.5% complication rate, including intracranial hemorrhage.
- The aneurysm group (n=24) had a 4.2% complication rate, including intracranial hemorrhage.
- Favorable outcomes were observed in 47.6% of the ischemic group and 56.2%-87.7% of the aneurysm group.
Conclusions:
- Intravenous cangrelor is a feasible alternative antiplatelet agent for neurovascular interventions.
- It facilitates transition to long-term therapy (e.g., ticagrelor) and surgical management if needed.
Purpose:
Thromboembolic events represent the most common procedure-related complication associated with neurointerventions. Cangrelor is a potent, intravenous (IV), P2Y12-receptor antagonist with a rapid onset and offset presented as an alternative antiplatelet agent. We aim to evaluate the safety and effectiveness of IV cangrelor in neurovascular intervention.
Methods:
This is a retrospective analysis of data from four cerebrovascular interventional centers. We identified patients who underwent acute neurovascular intervention and received cangrelor as part of their optimum care. Patients were divided into 2 groups: ischemic and aneurysm. Periprocedural thromboembolic events, hemorrhagic complications, and outcomes were analyzed.
Results:
Sixty-six patients were included, 42 allocated into the ischemic group (IG), and 24 into aneurysm group (AG). The IG periprocedural symptomatic complication rate was 9.5%, represented by 3 postoperative intracranial hemorrhages and 1 retroperitoneal hematoma. At discharge, 47.6% had a favorable outcome and the mortality rate was 2.4%, related to clinical deterioration of a large infarct. In the AG, 4.2% had a periprocedural complication during or after cangrelor infusion, represented by an intracranial hemorrhage in an initially ruptured aneurysm. Favorable clinical outcome was seen in 56.2% and 87.7% of ruptured and unruptured aneurysms, respectively, upon discharge.
Conclusions:
Cangrelor may be a feasible alternative for patients requiring immediate intervention with the use of endoluminal devices. It allows the possibility for a secure transition to long-term ticagrelor and progression to surgery in the setting of unexpected complications.
