Cangrelor, a newer P2Y12 inhibitor, in neuro-interventional procedures: a systematic review and updated meta-analysis

Cangrelor, a reversible P2Y12 receptor inhibitor commonly utilized in cardiovascular interventions, is increasingly being investigated for its potential in cerebrovascular applications. This study presents a comprehensive evaluation of its safety and efficacy in neuro-interventional procedures, based on a systematic review and meta-analysis of recent evidence.

We searched PubMed, Embase, Cochrane, Web of Science, and Scopus for studies on endovascular therapy with cangrelor-based intravenous antiplatelet therapy for cerebrovascular pathologies. Endpoints included 90-day functional outcomes, successful reperfusion (mTICI 2b-3), mortality, symptomatic intracranial hemorrhage (sICH), hemorrhagic transformation, gastrointestinal bleeding, intraprocedural complications (in-stent thrombosis, thromboembolic events), and retroperitoneal hematoma. Single-proportion analysis with 95% CIs under a random-effects model was conducted.

Seventeen studies with 646 patients were included. Favorable 90-day functional outcomes occurred in 57.06% (44.37-69.76%), and successful recanalization in 98.74% (96.63-100.00%). Rates of hemorrhagic transformation, sICH, gastrointestinal bleeding, and retroperitoneal hematoma were 24.06%, 4.64%, 0.02%, and 0.07%, respectively. Intraprocedural in-stent thrombosis occurred in 0.28%, thromboembolic events in 0.48%, and 90-day all-cause mortality was 7.94%.

The findings suggest that intravenous cangrelor, used as antiplatelet therapy following neuro-interventional procedures, is both safe and effective. This is reflected in high rates of favorable clinical outcomes, successful recanalization, and low complication rates.