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Updated: Jun 14, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Cangrelor for emergent carotid stenting during stroke thrombectomy: a comparative analysis versus glycoprotein
Raoul Pop1,2,3, Stephanos Nikolaos Finitsis4, Gaultier Marnat5
1Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France pop.raoul@gmail.com.
Insights
Cangrelor showed lower odds of favorable outcomes in emergent carotid artery stenting compared to glycoprotein IIb/IIIa inhibitors, but improved stent patency versus aspirin. Further research is needed.
Area of Science:
- Neuroendovascular treatment
- Cardiovascular pharmacology
Background:
- Periprocedural antiplatelet therapy is crucial for emergent carotid artery stenting (eCAS) during endovascular treatment (EVT) for stroke.
- Assessing cangrelor against glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors and aspirin monotherapy is vital for optimizing risk-benefit profiles.
Purpose of the Study:
- To compare the safety and efficacy of cangrelor versus GPIIb/IIIa inhibitors or aspirin monotherapy in patients undergoing eCAS for anterior circulation tandem lesions.
Main Methods:
- Retrospective analysis of 384 patients from the Endovascular Treatment in Ischemic Stroke (ETIS) registry (January 2015 - June 2023).
- Patients received periprocedural treatment with cangrelor, GPIIb/IIIa inhibitors, or aspirin monotherapy.
- Primary outcome: functional outcome at 90 days (modified Rankin Scale); Secondary outcomes: recanalization, hemorrhagic transformation, stent patency.
Main Results:
- Cangrelor was associated with poorer functional outcomes compared to GPIIb/IIIa inhibitors (aOR 0.48).
- Cangrelor improved carotid stent patency at day 1 versus aspirin (aOR 4.00) but showed no significant clinical outcome differences.
- GPIIb/IIIa inhibitors demonstrated higher odds of functional independence than aspirin (aOR 2.56).
Conclusions:
- Cangrelor may be associated with a trend towards lower odds of favorable clinical outcomes compared to GPIIb/IIIa inhibitors in eCAS.
- While cangrelor improved stent patency, findings require cautious interpretation due to potential selection bias.
- Further research is warranted to validate these findings in emergent stroke treatment.
Background:
Periprocedural antiplatelet treatment is a key determinant for the risk-benefit balance of emergent carotid artery stenting (eCAS) during stroke endovascular treatment (EVT). We aimed to assess the safety and efficacy profile of cangrelor compared with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors or aspirin monotherapy.
Methods:
Data were extracted from the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a prospective nationwide observational registry of stroke EVT in France. Included patients were treated with eCAS for anterior circulation tandem lesions between January 2015 and June 2023 and received periprocedural treatment with cangrelor, GPIIb/IIIa inhibitors or aspirin monotherapy. The primary outcome was functional outcome at 90 days, assessed by the modified Rankin Scale (mRS). Secondary outcomes included intracranial recanalization, hemorrhagic transformation and carotid stent patency at day 1.
Results:
Of the 1687 patients treated, 384 met the inclusion criteria: 91 received cangrelor, 77 received GPIIb/IIIa inhibitors and 216 aspirin monotherapy. Cangrelor was associated with a negative shift in the distribution of mRS scores compared with GPIIb/IIIa inhibitors (aOR 0.48, 95% CI 0.25 to 0.94, P=0.033). Compared with aspirin, cangrelor improved carotid stent patency at day 1 (aOR 4.00, 95% CI 1.19 to 14.29, P=0.025) but showed no significant differences in clinical outcomes. There were no differences in outcomes between full dose and low dose cangrelor. GPIIb/IIIa inhibitors demonstrated higher odds of functional independence (aOR 2.56, 95% CI 1.08 to 6.25, P=0.033) compared with aspirin.
Conclusions:
This registry-based study indicates a potential trend towards lower odds of favorable clinical outcomes with cangrelor treatment compared with GPIIb/IIIa inhibitors. However, these findings should be interpreted with caution due to potential selection bias and warrant further research for validation.
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