Acute ischemic stroke (AIS) with tandem cervical and intracranial disease is a morbid entity. Even with advances in endovascular therapies (EVT), 27% of treated patients have symptomatic ICH conversion. The use of IV Glycoprotein IIb/IIIa inhibitors (GPI) during acute stenting increases that risk. Cangrelor is a novel P2Y12 inhibitor delivered intravenously that has been proposed as an alternative.

This is a series of all cerebrovascular patients treated with EVT in whom Cangrelor was used between 1/2019 and 8/2019 in a single tertiary center.  We describe patient characteristics, technical and pharmacological details and outcomes.

There were 10 patients treated with Cangrelor, 50% were male, average age 59.6 years (SD 10.1), and weight 81.7 kg (SD 19.5). The diagnosis was stroke in 8 patients and aneurysm in 2. In stroke patients, 7 had tandem occlusion and 1 patient had ICAD. Standard dosing was used in all patients, with average bolus of 2469 mcg (SD 462) and an infusion rate of 306 mcg/min (SD 100). PRU was checked in 5 patients, 10 minutes after bolus with an average value of 32.6 (SD 59.5). 80% of patients were transitioned to clopidogrel, 20% to ticagrelor. All patients had follow up vessel imaging 1 day after the procedure. The patient who had ICAD had demonstrated occlusion of the stent, otherwise all stents remained patent. Post-operative MRI had no evidence of hemorrhage of any subtype in any of the patients. Cangrelor cost was $1294.4 per patient.

Cangrelor is a safe and effective alternative to GPI in patients undergoing emergent endovascular treatment of cerebrovascular pathologies requiring stenting, particularly patients with tandem occlusion. Further prospective studies are warranted.