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June 12, 2025Journal of NeuroInterventional Surgery

There were no significant differences between low-dose and high-dose cangrelor in intraprocedural thrombosis (13% vs 6%, p=0.078), thrombosis within 48 hours (9% vs 4%, p=0.093), intraprocedural bleeding (6% vs 5%, p=0.753), or intracranial hemorrhage within 48 hours (19% vs 25%, p=0.360).

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Why the study?

Effective antiplatelet therapy is essential during stenting to mitigate thrombosis risks, but consensus on optimal cangrelor dosing remains elusive.

Does high-dose cangrelor compared to low-dose cangrelor improve safety and efficacy in patients undergoing acute cerebrovascular stenting for ischemic stroke?

Population

230 patients aged 18-85 with ischemic stroke undergoing emergent cerebrovascular stenting

Comparison

Low-dose cangrelor (<2 mcg/kg/min) vs high-dose cangrelor (≥2 mcg/kg/min)

Design

Multicenter retrospective cohort study across 11 comprehensive stroke centers

Follow-up

Within 48 hours post-procedure

Authors

DHDevin HoldenJDJ. Spencer DingmanLSLauren Sutton

Discussion

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Overview

No difference in thrombotic or bleeding complications across cangrelor doses; leaves open optimal regimen pending prospective trials.

Structured PICO

Does high-dose cangrelor compared to low-dose cangrelor improve safety and efficacy in patients undergoing acute cerebrovascular stenting for ischemic stroke?

P
Population
230 patients aged 18-85 with acute ischemic stroke who underwent emergent cerebrovascular stenting with cangrelor across 11 comprehensive stroke centers.
I
Intervention
High-dose cangrelor (≥2 mcg/kg/min)
C
Comparator
Low-dose cangrelor (<2 mcg/kg/min)
O
Outcome
Thrombotic and bleeding complications both intra-procedurally and within 48 hours post-proceduresafety

Different cangrelor dosing regimens (<2 vs ≥2 mcg/kg/min) showed no significant differences in thrombotic or bleeding complications during acute neuroendovascular stenting for ischemic stroke.

Cite This Study

Holden et al. (2025) studied this question.

synapsesocial.com/papers/6a90a0223f736c3f82c7b343https://doi.org/10.1136/jnis-2025-023526
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Safety and efficacy of cangrelor in acute stenting for the treatment of cerebrovascular pathology: preliminary experience in a single-center pilot study2018 · 54 citations
  2. 2Efficacy and safety of low dose intravenous cangrelor in a consecutive cohort of patients undergoing neuroendovascular procedures2023 · 13 citations
  3. 3Cangrelor dose titration using platelet function testing during cerebrovascular stent placement2020 · 30 citations
  4. 4Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series2021 · 13 citations
  5. 5Use of intravenous cangrelor and stenting in acute ischemic stroke interventions: a new single center analysis and pooled-analysis of current studies2021 · 9 citations