Intraprocedural cangrelor during mechanical thrombectomy for acute ischemic stroke: a systematic review and single-arm meta-analysis

To evaluate the safety and efficacy of intravenous cangrelor administered during mechanical thrombectomy in patients with acute ischemic stroke. We conducted a systematic review and one-arm meta-analysis of prospective or retrospective studies reporting clinical or procedural outcomes after intraprocedural cangrelor use in adults undergoing thrombectomy for acute ischemic stroke. Pooled event rates and 95% confidence intervals (CIs) were calculated using a random-effects model. Leave-one-out sensitivity analyses were performed for all outcomes. Five studies including 131 patients were analyzed. The pooled rate of favorable functional outcome at 90 days (mRS 0-2) was 0.525 (95% CI: 0.286-0.753; I2 = 68.9%); sensitivity analysis showed stable estimates (range: 0.448-0.578). Successful reperfusion was achieved in 96.8% (95% CI: 0.894-0.991; I2 = 0%), with robust findings across all scenarios (range: 0.962-0.980). Hemorrhagic transformation occurred in 26.6% (95% CI: 0.168-0.395), and symptomatic intracranial hemorrhage in 9.4% (95% CI: 0.049-0.173), both with low-to-null heterogeneity. In-stent thrombosis and thromboembolic events were rare, with pooled rates of 2.0% (95% CI: 0.006-0.067) and 3.8% (95% CI: 0.014-0.098), respectively. Gastrointestinal bleeding and retroperitoneal hematoma were not observed, though the pooled rate for each remained at 2.0%. Ninety-day mortality was 30.9% (95% CI: 0.179-0.480), with consistent estimates across leave-one-out analyses (range: 0.234-0.362). Cangrelor appears to be a safe and effective intraprocedural antiplatelet agent during mechanical thrombectomy for acute ischemic stroke.