Intravenous cangrelor infusion for the treatment of traumatic intracranial internal carotid artery dissection: illustrative case

BACKGROUND: Antithrombotic initiation in patients with traumatic arterial dissections is weighed against the risk of bleeding complications. Cangrelor is a direct P2Y12 receptor blocker with rapid onset and reversibility. As such, its usage in polytrauma cases such as these, in which patients have both an elevated bleeding risk and an acute need for thromboembolic prevention, is advantageous. OBSERVATIONS: This case details cangrelor usage in a patient with a traumatic left cavernous internal carotid artery dissection as well as acute intracranial hemorrhage and other systemic injuries. No hemorrhagic or thromboembolic complications occurred during cangrelor therapy, which was eventually transitioned to oral aspirin. Outpatient follow-up angiography revealed successful healing of the carotid dissection. LESSONS: The authors present a case demonstrating the clinical utility of cangrelor therapy to treat traumatic arterial dissections and prevent thrombus formation while also maintaining the ability to achieve rapid reversal if bleeding were to occur or urgent surgical procedures were needed. https://thejns.org/doi/10.3171/CASE2559.