Abstract 260: Cangrelor without Stent

Background Periprocedural rethrombosis remains a significant challenge in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), contributing to the decoupling of initial angiographic success and favorable clinical outcomes. Intravenous cangrelor, a potent, direct‐acting, and rapidly reversible P2Y12 inhibitor, offers a theoretically ideal pharmacological profile for this setting. While its use is growing, literature has focused on its role as an adjunct to emergent stenting, with limited data on its application for preventing rethrombosis from underlying plaque or iatrogenic endothelial injury in the absence of permanent stent implantation. Methods We present a retrospective case series of 11 consecutive patients who received a “Neuro‐dose” cangrelor infusion (15 µg/kg bolus +/‐ 2 µg/kg/min infusion) during MT for AIS without further device implantation. Indications included prevention of rethrombosis due to underlying intracranial atherosclerotic disease (ICAD) and management of acute re‐thrombosis after successful recanalization, where stenting and irreversible platelet inhibition was deemed higher risk. Primary outcomes were successful vessel patency, rates of symptomatic intracranial hemorrhage (sICH), NIH delta at discharge, and 90‐day functional outcome (modified Rankin Scale score). Results Our series of 11 patients demonstrated successful prevention or management of rethrombosis in all cases. Symptomatic ICH occurred in 1 (9%) of patients. Pre‐infusion TICI score was >2b in 8/11 (73%) TICI score was >2b in 9/11 (82%) with 6/10 (60%) patients with TICI <3 improving to a greater TICI score after infusion. The one patient with sICH had suboptimal recanalization (2a) and despite decompressive hemicraniectomy had malignant cerebral edema and passed. Excluding this patient average NIH Delta at discharge was 6.5 points. Conclusion This case series supports the utility and flexibility in cangrelor as a destination therapy preventing the need for acute stenting, a critical and underreported application. The unique “on‐off" properties of cangrelor make it a valuable tool for dynamic, real‐time management of thrombotic and hemorrhagic risk. Further prospective studies are warranted.