Abstract TP13: Safety and Efficacy of Cangrelor in Acute Stenting for the Treatment of Cerebrovascular Pathology: Preliminary Experience in a Single-Center Pilot Study

Abstract

Background and Purpose: Acute ischemic stroke secondary to tandem occlusions or carotid stenosis alone present treatment challenges, especially when antiplatet therapy is needed for extracranial or intracranial stenting.. To date, there is no standardized approach for antiplatelet inhibition in this acute setting. Methods: A single-arm pilot study was performed to assess the safety and efficacy of cangrelor plus aspirin in neurointervention for platelet inhibition in patients who require acute stenting in the setting of ischemic stroke. A standard institution protocol was generated which included 15mcg/kg loading dose followed by 2.0mcg/kg/min infusion. Once post op imaging excluded hemorrhage this was converted to aspirin and brilinta and cangrelor was discontinued. Results: A total of 6 patients have been enrolled from October 2017 to July 2018. The median age was 73 years (57.5 - 85.3). At admission, the median NIHSS was 12.5 (2 - 22.3). All of the patients were treated in acute setting per the stroke protocol at our institution. Cangrelor was infusedand all patient achieved an adequate platelet inhibition (< 200 PRU (P2Y12 Reaction Units)). Five out 6 cases, had a proximal carotid stent placed and 1 patient underwent intracranial MCA stenting. None of the patients experienced periprocedural hemorrhagic or thromboembolic complications. There was also no in-stent thrombosis within 24 hours after the intervention. The majority of patients (4/6) had a good clinical outcome at discharge (mRS 0-2). Conclusions: Our findings suggest that Cangrelor is a promising alternative in acute stenting for the treatment of cerebrovascular pathology, however, further studies with larger samples are required to accurately elucidate its safety and effectiveness in neuroendovascular procedures.