Safety and efficacy of Cangrelor versus GPIIb/IIIa inhibitors as adjunctive therapy in endovascular treatment of acute ischemic stroke: a systematic review and meta-analysis

Endovascular treatment (EVT) plays a critical role in the management of acute ischemic stroke (AIS). To enhance reperfusion outcomes, intravenous antiplatelet agents such as glycoprotein IIb/IIIa inhibitors (GPIs) are commonly administered during EVT. cangrelor, a fast-acting, reversible P2Y12 inhibitor, has emerged as a potential alternative due to its rapid onset and offset of action. However, comparative data on its efficacy and safety relative to GPIs in this context are limited. This study aimed to systematically evaluate the efficacy and safety of cangrelor versus GPIs as adjunctive antiplatelet therapies during EVT in AIS patients. We conducted a systematic review and meta-analysis following PRISMA guidelines, with protocol registration on PROSPERO (CRD420251047232). A comprehensive literature search was performed in PubMed, Scopus, and Web of Science, through May 4, 2025. Studies comparing cangrelor and GPIs during EVT in AIS were included. Data on procedural success, intracranial hemorrhage, and mortality were extracted and analyzed using Review Manager 5.4. Five studies including 616 participants (cangrelor: 318, GPIs: 298) were included. No significant difference was observed between groups in achieving the modified treatment in cerebral infarction (mTICI) score ≥ 2b (RR = 1.04, 95% CI [1.00–1.09], P = 0.07), mTICI ≥ 2c (RR = 1.19 (95% CI [0.87, 1.61], P = 0.27), or mTICI ≥ 3 (RR = 1.07 (95% CI [0.81 to 1.42], p = 0.62). Safety outcomes, including symptomatic intracranial hemorrhage and mortality, were comparable. Despite limited data, current evidence indicates that cangrelor may serve as a viable alternative to GPIs in the EVT of AIS, with comparable efficacy and safety profiles. However, definitive conclusions require validation through well-designed prospective randomized trials.