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Updated: Apr 8, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Intravenous cangrelor as rescue therapy for acute thrombosis in neuroendovascular procedures: illustrative cases
Mehlika Esra Sahin1, Amy T Fulton1, Sunishka Deshpande1
1Department of Neurosurgery, Duke University, Durham, North Carolina.
Insights
Cangrelor, an IV antiplatelet drug, shows promise as a rescue therapy for neurovascular procedures. It effectively resolved thrombus in most patients undergoing cerebral aneurysm embolization, with no adverse events.
Area of Science:
- Neurology
- Cardiology
- Interventional Radiology
Background:
- Clot formation poses risks during endovascular procedures.
- Cangrelor is an FDA-approved IV antiplatelet for coronary interventions.
- Its role in neurovascular rescue therapy is not established.
Purpose of the Study:
- To evaluate cangrelor as a rescue therapy for thrombolysis during neurovascular procedures.
- To assess the safety and efficacy of cangrelor in cerebral aneurysm embolization.
Main Methods:
- Retrospective review of 4 patients receiving IV cangrelor for emergency thrombolysis.
- Cerebral aneurysm embolization procedures were analyzed.
- Outcomes included thrombus resolution, blood flow restoration, and complications.
Main Results:
- Thrombus resolution occurred within minutes in 3 of 4 patients, restoring blood flow.
- Cangrelor facilitated partial thrombolysis with mechanical thrombectomy in 1 patient.
- No ischemic stroke or hemorrhagic complications were observed; all patients returned to baseline.
Conclusions:
- Cangrelor demonstrated safety and efficacy as an IV platelet inhibitor for emergency thrombolysis post-cerebral aneurysm embolization.
- Its rapid onset, reversible inhibition, and short half-life make it an attractive rescue agent.
Background:
Clot formation can lead to serious complications associated with endovascular procedures. Cangrelor, a novel intravenous (IV) antiplatelet medication, has been FDA approved for percutaneous coronary intervention. However, the use of cangrelor for the purpose of rescue therapy in neurovascular procedures has not been established.
Observations:
At the authors' institution, 4 patients received IV cangrelor for emergency thrombolysis during cerebral aneurysm embolization. In 3 cases, thrombus resolution was observed within minutes of cangrelor administration, restoring normal flow. In 1 case, cangrelor facilitated partial thrombolysis in conjuction with mechanical thrombectomy. No patient experienced an ischemic stroke or hemorrhagic complication. All patients were discharged home at their neurological baseline. Follow-up demonstrated no recurrent thrombosis or aneurysm recurrence.
Lessons:
In this limited series, cangrelor was found to be a safe and effective IV platelet inhibitor with emergency thrombolysis capability after cerebral aneurysm embolization. Cangrelor is an attractive rescue agent due to its rapid onset, reversible P2Y12 inhibition, and extremely short half-life (on/off effect). https://thejns.org/doi/10.3171/CASE25930.
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