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Updated: Jul 8, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Intravenous cangrelor use for neuroendovascular procedures: a two-center experience and updated systematic review
Harsh Desai1, Mohammed Maan Al-Salihi2, Rami Z Morsi1
1Department of Neurology, University of Chicago, Chicago, IL, United States.
Insights
Intravenous cangrelor is safe and effective for neuroendovascular procedures, showing low bleeding and ischemic event rates. Further research is needed to optimize cangrelor dosing protocols.
Area of Science:
- Neuroendovascular interventions
- Pharmacology
- Interventional Neurology
Background:
- Optimal antiplatelet therapy for neuroendovascular procedures is not well-defined.
- Intravenous cangrelor is being investigated for acute neuroendovascular interventions.
Purpose of the Study:
- To evaluate the safety and feasibility of intravenous dose-adjusted cangrelor.
- To assess outcomes in patients undergoing neuroendovascular procedures with cangrelor therapy.
Main Methods:
- Retrospective chart review of 76 patients receiving intravenous cangrelor.
- Systematic review and meta-analysis of 11 studies with 298 patients.
Main Results:
- Cangrelor was frequently used for embolization and intracranial stent placement.
- Favorable outcomes (mRS 0-2) at 90 days were observed in 44% of patients.
- Low rates of stroke (8%), symptomatic intracranial hemorrhage (6%), and bleeding events (3-6%) were reported.
Conclusions:
- Intravenous cangrelor demonstrates safety and efficacy in neuroendovascular procedures.
- Low rates of bleeding and ischemic complications were observed.
- Further research on cangrelor dosing and comparison with other agents is warranted.
Background:
The optimal antiplatelet therapy regimen for certain neuroendovascular procedures remains unclear. This study investigates the safety and feasibility of intravenous dose-adjusted cangrelor in patients undergoing acute neuroendovascular interventions.
Methods:
We conducted a retrospective chart review of all consecutive patients on intravenous cangrelor for neuroendovascular procedures between September 1, 2020, and March 13, 2022. We also conducted an updated systematic review and meta-analysis using PubMed, Scopus, Web of Science, Embase and the Cochrane Library up to February 22, 2023.
Results:
In our cohort, a total of 76 patients were included [mean age (years): 57.2 ± 18.2, males: 39 (51.3), Black: 49 (64.5)]. Cangrelor was most used for embolization and intracranial stent placement (n = 24, 32%). Approximately 44% of our patients had a favorable outcome with a modified Rankin Scale (mRS) score of 0 to 2 at 90 days (n = 25/57); within 1 year, 8% of patients had recurrent or new strokes (n = 5/59), 6% had symptomatic intracranial hemorrhage [sICH] (4/64), 3% had major extracranial bleeding events (2/64), and 3% had a gastrointestinal bleed (2/64). In our meta-analysis, 11 studies with 298 patients were included. The pooled proportion of sICH and intraprocedural thromboembolic complication events were 0.07 [95% CI 0.04 to 1.13] and 0.08 [95% CI 0.05 to 0.15], respectively.
Conclusion:
Our study found that intravenous cangrelor appears to be safe and effective in neuroendovascular procedures, with low rates of bleeding and ischemic events. However, further research is needed to compare different dosing and titration protocols of cangrelor and other intravenous agents.
