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.