Cangrelor and Stenting in Acute Ischemic Stroke

Elhorany, Mahmoud; Lenck, Stéphanie; Degos, Vincent; Sourour, Nader‐Antoine; Polara, Giulia Frasca; Shotar, Eimad; Godiér, Anne; Drir, Mehdi; Mahtout, Jugurtha; Premat, Kévin; Alamowitch, Sonia; Samson, Yves; Clarençon, Frédéric

doi:10.1007/s00062-020-00907-0

Cited by 28 publications

(27 citation statements)

References 24 publications

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“…16 Given the growing evidence supporting the use of this drug in patients with STEMI undergoing PCI, some investigators have started to test its efficacy and safety in neurointerventional procedures. [11][12][13][14] Our results are in accordance with those reported by Aguilar-Salinas et al 11 describing, in a small case series, patients undergoing emergency stent placement for acute ischemic stroke or symptomatic intracranial aneurysms treated with periprocedural cangrelor at half of the standard dose for PCI. Similarly, another study 14 also reported the efficacy of a full dose of this drug in the antiplatelet management of the acute stroke phase in either stent-assisted coiling or flow-diverter treatment of intracranial aneurysms.…”

Section: Discussionsupporting

confidence: 92%

“…To date, very few studies have been performed to evaluate cangrelor efficacy during emergency neuroendovascular procedures. [11][12][13][14] Indeed, only 27 patients with AIS eligible for stent implantation and subsequently treated with cangrelor administration have been described in literature, [11][12][13] and to the best of our knowledge, our study describes, to date, the largest series of patients with AIS undergoing acute stent placement and cangrelor administration.…”

Section: Discussionmentioning

confidence: 93%

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Use of Cangrelor in Cervical and Intracranial Stenting for the Treatment of Acute Ischemic Stroke: A “Real Life” Single-Center Experience

Cervo¹,

Ferrari

Barchetti

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:In cases of large-vessel-occlusion strokes due to an underlying tandem internal carotid artery occlusion or intracranial atherosclerotic disease, concomitant stent placement may be needed. Immediate platelet inhibition is necessary, but to date, a standardized approach for antiplatelet inhibition in acute settings is still missing. Here we report our single-center experience about the safety and efficacy of periprocedural administration of cangrelor in patients with acute ischemic stroke due to intracranial or cervical artery occlusion undergoing stent placement.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 93%

Use of Cangrelor in Cervical and Intracranial Stenting for the Treatment of Acute Ischemic Stroke: A “Real Life” Single-Center Experience

Cervo¹,

Ferrari

Barchetti

et al. 2020

AJNR Am J Neuroradiol

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“…In a study by Linfante et al, full cardiac dosing of cangrelor was used in five ischemic stroke patients and resulted in gastrointestinal bleeding in one patient (33). A French study with a similar cangrelor dosing regimen resulted in one case of symptomatic intracranial hemorrhage, two cases of asymptomatic intracranial hemorrhage, and one retroperitoneal bleed amongst 12 stroke patients (31). The largest case series published from Italy found no cases of peri-procedural instent thrombosis in 38 AIS patients requiring acute stenting and three cases of delayed in-stent thrombosis when cangrelor was transitioned to an antiplatelet other than ticagrelor.…”

Section: Discussionmentioning

confidence: 99%

Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series

et al. 2021

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Background: Neurointerventional procedures in acute ischemic stroke often require immediate antiplatelet therapy in the cases of acute stenting and occasionally re-occluding vessels. Intravenous cangrelor is a P2Y12 receptor antagonist with short onset and quick offset. The study objective was to evaluate the safety and efficacy of intravenous cangrelor in patients with acute ischemic stroke requiring urgent antiplatelet effect.Methods: Patients who received intravenous cangrelor intra-procedurally during acute ischemic stroke treatment were identified from a prospectively collected database. Cangrelor was administered as a bolus of 15 mcg/kg, followed by an infusion rate of 2 mcg/kg/min. A historical control group consisting of anterior circulation tandem occlusions was used to compare to patients with similar lesions who received intravenous cangrelor. Outcomes of interest included in-stent thrombosis, thromboembolic complications, intracranial hemorrhage, and functional outcomes at 90 days.Results: Twelve patients received intravenous cangrelor for acute ischemic stroke between October 2018 and April 2020 at a comprehensive stroke center. Eleven patients had intra or extracranial stenting performed, which included two posterior circulation lesions. No cases of symptomatic intracranial hemorrhage were reported. At 90 day follow-up, two patients had died and 10 had a good functional outcome. Patients with anterior circulation tandem occlusions who received cangrelor and those who received dual antiplatelets orally had similar radiographic and clinical outcomes.Conclusion: Low dose intravenous cangrelor is similar in safety and efficacy to oral antiplatelets in acute ischemic stroke in a small case series. Larger prospective studies on the efficacy, safety, and effect on procedure times of intravenous cangrelor in neurointervention are warranted.

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“…Data for the use of cangrelor during neuroendovascular stenting are limited but increasing (Table 3). 7–15 Our center utilized PFT prior to using cangrelor, and PFT was incorporated into our cangrelor protocol once we began using this drug.…”

Section: Discussionmentioning

confidence: 99%

“…Cangrelor is a new‐generation intravenous P2Y12 inhibitor, extensively utilized for percutaneous coronary intervention (PCI), which has rapid onset and offset, has organ‐independent metabolism, is easily measurable, and permits for easy transition to an oral agent 5,6 . Data for the use of cangrelor during neuroendovascular stenting are limited but increasing 7–15 . Studies to date have shown significant variability in the dose of cangrelor utilized, and dose titration using platelet function testing (PFT) has only been reported in one study 11 .…”

Section: Introductionmentioning

confidence: 99%

Characterization of antiplatelet response to low‐dose cangrelor utilizing platelet function testing in neuroendovascular patients

et al. 2021

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Study Objectives The optimal antiplatelet therapy for emergent neuroendovascular stenting is uncertain. Cangrelor is an intravenous P2Y12 inhibitor that is an attractive option due its favorable pharmacokinetic profile and ease of measurability but optimal dosing remains unclear. The primary objective of this study is to characterize the dose response of low dose cangrelor (<2 mcg/kg/min) with the utilization of platelet function testing (PFT). Design A retrospective review of all patients treated with cangrelor for either procedural stenting or bridging was conducted between January 1st, 2019 and October 31st, 2020. Seventy‐two patients met inclusion criteria. An in‐depth analysis of dose response to low dose cangrelor based on PFT was performed. Patients Neuroendovascular patients treated with cangrelor. Setting Albany Medical Center Hospital. Intervention and Main Results Patients who underwent procedural stenting were given a bolus of 5 mcg/kg and an initial infusion rate of either 0.75 mcg/kg/min or 1 mcg/kg/min. Patients who were bridged with cangrelor were administered an initial infusion rate of 0.75 mcg/kg/min or 1 mcg/kg/min. Twelve patient’s doses were titrated to achieve a platelet reactivity unit (PRU) between 50–150; three patient’s doses were titrated multiple times. Based on initial PFT results, utilizing the 1 mcg/kg/min maintenance dose resulted in more patients being in the acceptable (10–180) and desired (50–150) PRU range than the 0.75 mcg/kg/min dose (47% vs 56% and 70% vs 80%, respectively). Final recorded PRU results showed that 64% of patients had PRUs in the optimal range (50–150) and 88% of patients had PRUs in the desire range (10–180). Conclusions Utilizing low doses of cangrelor with platelet function testing is an option during emergent neuroendovascular stenting and bridging. Cangrelor demonstrates significant variability in response at low doses and exhibits a dose response relationship when PFT is utilized.

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Cangrelor and Stenting in Acute Ischemic Stroke

Cited by 28 publications

References 24 publications

Use of Cangrelor in Cervical and Intracranial Stenting for the Treatment of Acute Ischemic Stroke: A “Real Life” Single-Center Experience

Use of Cangrelor in Cervical and Intracranial Stenting for the Treatment of Acute Ischemic Stroke: A “Real Life” Single-Center Experience

Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series

Characterization of antiplatelet response to low‐dose cangrelor utilizing platelet function testing in neuroendovascular patients

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