Key result
Low dose intravenous cangrelor during neuroendovascular procedures was associated with a 4.9% rate of stent occlusion and a 2% rate of major hemorrhage at 24 hours.
Why the study?
Dose-adjusted cangrelor based on platelet function testing has been suggested to be advantageous during neuroendovascular procedures, but its efficacy and safety required assessment.
Does low dose intravenous cangrelor prevent stent occlusion or persistent intraluminal thrombus in patients undergoing neuroendovascular procedures?
Cohort (n=101)
Does low dose intravenous cangrelor prevent stent occlusion or persistent intraluminal thrombus in patients undergoing neuroendovascular procedures?
Low dose intravenous cangrelor appears effective for preventing stent thrombosis during neuroendovascular procedures with a low risk of major hemorrhage.
Answers are grounded in this paper and cite their sources.
Low rates of occlusion and hemorrhage with low-dose cangrelor support further evaluation; leaves open efficacy confirmation in randomized neuroendovascular trials.
BACKGROUND: Cangrelor is an intravenous P2Y12 inhibitor with rapid onset and fast offset of antiplatelet action. Dose adjusted cangrelor based on platelet function testing is suggested to be advantageous for use during neuroendovascular procedures. In this study, we aimed to assess the efficacy and safety of this strategy. METHODS: This retrospective study included consecutive patients who received low dose intravenous cangrelor (5 µg/kg; infusion 1 µg/kg/min) for ruptured (RIA) and unruptured (UIA) intracranial aneurysms, and acute ischemic stroke (AIS). Indications were acute stenting or intraluminal thrombus. Outcomes were assessed at 24 hours by brain CT and CT angiography. The primary efficacy outcome was the rate of stent occlusion or persistent intraluminal thrombus. The primary safety outcome was the rate of major hemorrhages. RESULTS: 101 patients (56 men; median age (IQR) 59 (51-70) years) received low dose cangrelor for acute stenting (79/101 (78%)) and intraprocedural thrombus (22/101 (22%)). Overall, 5 (4.9%) patients experienced stent occlusion within 24 hours (RIA 3/28; AIS 2/52). There were no cases of failure among UIA patients. Stent mis-opening (fish mouthing or stenosis >50%) was significantly associated with stent occlusion (P<0.001). The overall rate of major hemorrhage was 2% (2/101), which occurred in AIS patients. Platelet reactivity unit (PRU) values were lower in those presenting with major hemorrhage (PRU 4 (SD 1.4) vs PRU 60 (SD 63); P=0.043). Mortality rate after cangrelor related hemorrhage was 1%. CONCLUSIONS: Low dose cangrelor appears to be effective in preventing stent thrombosis and arterial patency with a low hemorrhagic risk.
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Cagnazzo et al. (2023) conducted a cohort in Intracranial aneurysms and acute ischemic stroke (n=101). Low dose intravenous cangrelor was evaluated on Rate of stent occlusion or persistent intraluminal thrombus. Low dose intravenous cangrelor during neuroendovascular procedures was associated with a 4.9% rate of stent occlusion and a 2% rate of major hemorrhage at 24 hours.
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