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The use of cangrelor in neurovascular interventions: a multicenter experience

  • Interventional Neuroradiology
  • Published:
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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.

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Acknowledgements

This study aligns with the STROBE statement for observational studies.

Funding

A research grand was provided by Chiesi USA, Inc. to one of the centers (Grant Number: N/A). No other specific grant from funding agencies in the public, commercial, or not-for-profit sectors were received.

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Authors and Affiliations

  1. Lyerly Neurosurgery, Baptist Neurological Institute, 800 Prudential drive, Weaver tower, 11th floor, Jacksonville, FL, USA

    Gustavo M. Cortez, André Monteiro, Yasmeen Murtaza, Amin Aghaebrahim, Eric Sauvageau & Ricardo A. Hanel

  2. Research Department, Jacksonville University, Jacksonville, FL, USA

    Gustavo M. Cortez

  3. Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France

    Nader Sourour, Frédéric Clarençon & Mahmoud Elhorany

  4. Adventist Health Glendale Comprehensive Stroke Center, Los Angeles, CA, USA

    Mikayel Grigoryan & Soz Mirza

  5. Miami Neuroscience, Cardiac, and Vascular Institute, Baptist Hospital, Miami, FL, USA

    Guilherme Dabus & Italo Linfante

  6. Department of Neurosurgery, University of Arizona, Tucson, AZ, USA

    Pedro Aguilar-Salinas

Authors
  1. Gustavo M. Cortez
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  2. André Monteiro
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Contributions

All the co-authors contributed equally to prepare and accomplish this manuscript. GC was responsible for writing the manuscript, with modification upon to the co-author’s revisions and suggestions. RH supervised, coordinated, and critically reviewed the manuscript.

Corresponding author

Correspondence to Ricardo A. Hanel.

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Conflict of interest

Dr. Sourour is a consultant for Medtronic, Balt, and Microvention. Dr. Clarençon reports conflict of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings), Codman Neurovascular, and Microvention (core lab). Dr. Dabus is a consultant for Medtronic, Microvention, Cerenovus, and Penumbra. Dr. Linfante is a consultant for Medtronic, Stryker, and Prolong Pharmaceuticals and a stockholder for InNeuroCo and Three Rivers. Dr. Hanel reports conflict of interest with Medtronic, Stryker, Cerenovous, Microvention, Balt, Phenox, MiVI, and Codman and is a stockholder for Neurvana, Elum, Endostream, Three Rivers Medical Inc., Synchron, RisT, Cerebrotech, Deinde, BendIT, and InNeurCo. All the other authors have no disclosure to report.

We declare we do not have conflict of interest with the present study.

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This study was approved by each institution local ethics committee. As this was a retrospective analysis, additional written informed consent was waived.

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Cortez, G.M., Monteiro, A., Sourour, N. et al. The use of cangrelor in neurovascular interventions: a multicenter experience. Neuroradiology 63, 925–934 (2021). https://doi.org/10.1007/s00234-020-02599-2

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