Key result
Cangrelor was associated with a similar rate of 90-day favorable outcome compared to GPIIb/IIIa inhibitors in large vessel occlusion stroke (43.7% vs 41.7%; OR 1.1; 95% CI 0.61-1.93).
Why the study?
While glycoprotein IIb/IIIa inhibitors have been widely studied in ischemic stroke, cangrelor remains less explored as adjunctive therapy during endovascular treatment.
Does cangrelor improve 90-day favorable outcomes compared to GPIIb/IIIa inhibitors in patients with large vessel occlusion stroke undergoing endovascular treatment?
Cohort (n=559)
Yes
Does cangrelor improve 90-day favorable outcomes compared to GPIIb/IIIa inhibitors in patients with large vessel occlusion stroke undergoing endovascular treatment?
Odds Ratio: 1.1 (95% CI 0.61–1.93)
Absolute Event Rate: 43.7% vs 41.7%
Cangrelor demonstrates comparable safety and efficacy to GPIIb/IIIa inhibitors as adjunctive therapy during endovascular treatment for complex large vessel occlusion stroke.
Cangrelor may serve as alternative to GPIIb/IIIa inhibitors in stroke EVT; leaves open need for RCTs to guide practice.
BACKGROUND: Endovascular treatment (EVT) failures and early reocclusions in stroke often result from arterial wall disease, incomplete thrombus withdrawal, or acute endothelial injury. Intracranial and extracranial atherosclerosis, in particular, poses a risk of reocclusion, sometimes requiring tailored interventions (eg, angioplasty, stenting). While glycoprotein (GP) IIb/IIIa inhibitors have been widely studied in ischemic stroke, cangrelor remains less explored. OBJECTIVE: To evaluate the safety and efficacy of cangrelor compared with GPIIb/IIIa inhibitors in large vessel occlusion stroke (LVOS). METHODS: This retrospective analysis from the Endovascular Treatment in Ischemic Stroke Registry included patients from 34 French centers who received cangrelor or GPIIb/IIIa inhibitors during EVT between July 2018 and September 2023. Eligible cases had refractory occlusions or arterial disease at risk of reocclusion. The primary outcome was a 90-day favorable outcome. Secondary outcomes included excellent functional outcome, early neurological improvement, intracranial hemorrhage (ICH), procedural complications, and day 1 arterial patency. Propensity score overlap weighting was used for comparisons. RESULTS: Of 559 patients, 160 received GPIIb/IIIa inhibitors and 399 received cangrelor. Favorable outcomes were comparable (41.7% vs 43.7%; OR=1.1; 95% CI 0.61 to 1.93), as were rates of excellent functional outcome and early neurological improvement. Angiographic efficacy was similar, with modified Thrombolysis in Cerebral Infarction ≥2b rates of 89.5% for GPIIb/IIIa and 90.1% for cangrelor. No significant differences were observed in day 1 patency, 90-day mortality, or symptomatic ICH. CONCLUSIONS: Cangrelor showed comparable safety and efficacy to GPIIb/IIIa inhibitors. These results, along with the specific pharmacodynamics, make this drug a promising agent in the acute management of complex intracranial and extracranial LVOS. TRIAL REGISTRATION NUMBER: NCT03776877.
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Milnerowicz et al. (2025) conducted a cohort in Large vessel occlusion stroke (LVOS) (n=559). Cangrelor vs. GPIIb/IIIa inhibitors was evaluated on 90-day favorable outcome (OR 1.1, 95% CI 0.61 to 1.93). Cangrelor was associated with a similar rate of 90-day favorable outcome compared to GPIIb/IIIa inhibitors in large vessel occlusion stroke (43.7% vs 41.7%; OR 1.1; 95% CI 0.61-1.93).
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