Use of cangrelor for complex percutaneous coronary intervention in the context of concomitant severe aortic stenosis:
Francesco Soriano1, Andrea R Munafò1, Nurcan Baydaroglu1
1Interventional Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
Insights
Cangrelor, a P2Y12 inhibitor, can minimize bleeding and thrombotic risks during transcatheter aortic valve implantation (TAVI) with percutaneous coronary intervention (PCI). This approach offers tailored platelet inhibition for complex procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Increasing need for combined transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI).
- Cangrelor offers rapid P2Y12 inhibition with short offset, potentially reducing complications.
- Large-bore arterial access (LBAA) in TAVI/PCI increases bleeding and vascular risks.
Background:
There is a growing need for percutaneous coronary intervention (PCI) to be performed within the same transcatheter aortic valve implantation (TAVI) procedure. In such cases, cangrelor, a fast-acting intravenous P2Y12-inhibitor with a short offset, is potential clinical utility to minimize bleeding and vascular complications during large-bore arterial access (LBAA) as well as the thrombotic risk associated with concomitant PCI.
Case Summary:
We report two cases of TAVI with an indication to concomitant, high-risk PCI. In the first one, cangrelor was started only after LBAA was secured and TAVI completed, just before the initiation of complex PCI. In the second case, due to predicted complex coronary cannulation after TAVI, complex PCI was performed before TAVI and cangrelor started just after LBAA. In both cases, use of cangrelor (vs. pre-treatment with oral P2Y12-i) allowed for a tailored minimization of the risk of bleeding and vascular complications during LBAA while offering full platelet inhibition during a complex/high-risk PCI.
Discussion:
In this case series, we illustrate a possible approach to the use of cangrelor for patients undergoing TAVI and complex/high-risk PCI. In such complex cases, thorough pre-procedural planning might include a cangrelor to minimize vascular, bleeding, and ischaemic complications.
