Preliminary Experience with Cangrelor for Endovascular Treatment of Challenging Intracranial Aneurysms
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ORIGINAL ARTICLE
Preliminary Experience with Cangrelor for Endovascular Treatment of Challenging Intracranial Aneurysms Lamine Abdennour1 · Nader Sourour2 · Mehdi Drir1 · Kévin Premat2,3 · Eimad Shotar2 · Guillaume Taylor4 · Anne Godier5 · Jugurtha Mathout1 · Stéphanie Lenck2 · Remy Bernard1 · Alexandre Carpentier3,6 · Vincent Degos1,3 · Frédéric Clarençon2,3 Received: 18 March 2019 / Accepted: 27 June 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Background and Purpose Cangrelor is a P2Y12 inhibitor that presents the advantage of having a short half-life. Its use may be helpful in the management of antiplatelet therapy for patients with intracranial aneurysms treated by stent-assisted coiling or flow-diverter stents. The purpose of this study was to report early experiences in using cangrelor for such indications. Material and Methods From October 2017 to November 2018, 7 consecutive patients (5 females, 2 males, mean age = 56 years) were managed with cangrelor as antiplatelet therapy, combined with aspirin, for stent-assisted coiling embolization and flow-diverter embolization of challenging intracranial aneurysms. Anti-aggregation protocols, including cangrelor, were systematically recorded. Treatment-related complications (minor/major hemorrhagic complications, ischemic complications) as well as clinical and angiographic outcomes (evaluated at 8.7 ± 4.2 and 8.75 ± 10 months, respectively) were retrospectively analyzed. Results Of the aneurysms 71.4% (5 out of 7) were ruptured and treated in the acute phase. In one case cangrelor was used as an alternative to clopidogrel in an asymptomatic hemorrhagic complication after stent-assisted coiling for better control of a possible worsening of the intracranial bleeding. Of the patients, 1 (14%) with a complex ruptured MCA aneurysm treated with a flow-diverter stent experienced a severe intracranial hemorrhage, which occurred after switching the cangrelor to ticagrelor and eventually led to death. No hemorrhagic complications under cangrelor were recorded for the six remaining patients. No mRS worsening was observed at discharge, except for the patient who died and six out of the seven patients had a mRS Ä2 at follow-up. Conclusion Cangrelor is a new antiplatelet therapy with a P2Y12 inhibiting effect, with a rapid onset and offset of action, owing to its short half-life. This cases series presents a pilot experience with promising results in terms of antiplatelet management for challenging intracranial aneurysms treated by stent assisted coiling or flow-diverter stents.
Keywords Cangrelor · Antiaggregation platelet therapy · Flow diversion · Stent-assisted coiling · Hemorrhagic complication
3
Sorbonne University, Paris, France
4
Neuro-Intensive Care Unit, Fondation A. de Rothschild, Paris, France
5
Department of Anesthesiology, Hôpital Européen Georges Pompidou, INSERM UMRS-1140, université Paris Descartes, Paris, France
6
Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
Frédéric Clarençon
frederic.clare
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