The use of cangrelor in neurovascular interventions: a multicenter experience
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INTERVENTIONAL NEURORADIOLOGY
The use of cangrelor in neurovascular interventions: a multicenter experience Gustavo M. Cortez 1,2 & André Monteiro 1 & Nader Sourour 3 & Frédéric Clarençon 3 & Mahmoud Elhorany 3 & Mikayel Grigoryan 4 & Soz Mirza 4 & Guilherme Dabus 5 & Italo Linfante 5 & Pedro Aguilar-Salinas 6 & Yasmeen Murtaza 1 & Amin Aghaebrahim 1 & Eric Sauvageau 1 & Ricardo A. Hanel 1 Received: 7 September 2020 / Accepted: 3 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Thromboembolic events represent the most common procedure-related complication associated with neurointerventions. Cangrelor is a potent, intravenous (IV), P2Y12-receptor antagonist with a rapid onset and offset presented as an alternative antiplatelet agent. We aim to evaluate the safety and effectiveness of IV cangrelor in neurovascular intervention. Methods This is a retrospective analysis of data from four cerebrovascular interventional centers. We identified patients who underwent acute neurovascular intervention and received cangrelor as part of their optimum care. Patients were divided into 2 groups: ischemic and aneurysm. Periprocedural thromboembolic events, hemorrhagic complications, and outcomes were analyzed. Results Sixty-six patients were included, 42 allocated into the ischemic group (IG), and 24 into aneurysm group (AG). The IG periprocedural symptomatic complication rate was 9.5%, represented by 3 postoperative intracranial hemorrhages and 1 retroperitoneal hematoma. At discharge, 47.6% had a favorable outcome and the mortality rate was 2.4%, related to clinical deterioration of a large infarct. In the AG, 4.2% had a periprocedural complication during or after cangrelor infusion, represented by an intracranial hemorrhage in an initially ruptured aneurysm. Favorable clinical outcome was seen in 56.2% and 87.7% of ruptured and unruptured aneurysms, respectively, upon discharge. Conclusions Cangrelor may be a feasible alternative for patients requiring immediate intervention with the use of endoluminal devices. It allows the possibility for a secure transition to long-term ticagrelor and progression to surgery in the setting of unexpected complications. Keywords Cangrelor . Stroke . Aneurysm . Thromboembolism . Intracranial hemorrhage
Introduction * Ricardo A. Hanel [email protected] 1
Lyerly Neurosurgery, Baptist Neurological Institute, 800 Prudential drive, Weaver tower, 11th floor, Jacksonville, FL, USA
2
Research Department, Jacksonville University, Jacksonville, FL, USA
3
Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
4
Adventist Health Glendale Comprehensive Stroke Center, Los Angeles, CA, USA
5
Miami Neuroscience, Cardiac, and Vascular Institute, Baptist Hospital, Miami, FL, USA
6
Department of Neurosurgery, University of Arizona, Tucson, AZ, USA
Thromboembolic events (TE) may lead to catastrophic complications in patients undergoing endovascular treatment for cerebrovascular diseases. In cases of endoluminal prosthesis utilization, d
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