Low dose intravenous cangrelor versus glycoprotein IIb/IIIa inhibitors in endovascular treatment of tandem lesions

Mouhammad A. Jumaa, Aaron Rodriguez-Calienes, Giana Dawod, Juan Vivanco-Suarez, Ameer E. Hassan, Afshin A. Divani, Marion Oliver, Marc Ribo, Nils Petersen, Michael Abraham, Johanna Fifi, Waldo R. Guerrero, Amer M. Malik, James E. Siegler, Thanh Nguyen, Sunil Sheth, Albert Yoo, Guillermo Linares, Nazli Janjua, Darko Quispe-OrozcoMilagros Galecio-Castillo, Cynthia Zevallos, Marco Malaga, Mudassir Farooqui, Tudor Jovin, Syed Zaidi, Santiago Ortega-Gutierrez

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Intravenous (IV) periprocedural antiplatelet therapy (APT) for patients undergoing acute carotid stenting during mechanical thrombectomy (MT) is not fully investigated. We aimed to compare the safety profile of IV low dose cangrelor versus IV glycoprotein IIb/IIIa (GP-IIb/IIIa) inhibitors in patients with acute tandem lesions (TLs). Materials and methods: We retrospectively identified all cases of periprocedural administration of IV cangrelor or GP-IIb/IIIa inhibitors during acute TLs intervention from a multicenter collaboration. Patients were divided in two groups according to the IV APT regimen at the time of MT procedure: 1) cangrelor and 2) GP-IIb/IIIa inhibitors (tirofiban and eptifibatide). Safety outcomes included rates of symptomatic intracranial hemorrhage (sICH), parenchymal hematoma type 1 and 2 (PH1-PH2), and hemorrhagic infarction type 1 and 2 (HI1-HI2). Results: Sixty-three patients received IV APT during MT, 30 were in the cangrelor group, and 33 were in the GP-IIb/IIIa inhibitors group. There were no significant differences in the rates of sICH (3.3% vs. 12.1%, aOR=0.21, 95%CI 0.02–2.18, p=0.229), HI1-HI2 (21.4% vs 42.4%, aOR=0.21, 95%CI 0.02–2.18, p=0.229), and PH1-PH2 (17.9% vs. 12.1%, aOR=1.63, 95%CI 0.29–9.83, p=0.577) between both treatment groups. However, there was a trend toward reduced hemorrhage rates with cangrelor. Cangrelor was associated with increased odds of complete reperfusion (aOR=5.86; 95%CI 1.57–26.62;p=0.013). Conclusions: In this retrospective non-randomized cohort study, our findings suggest that low dose cangrelor has similar safety and increased rate of complete reperfusion compared to IV GP-IIb/IIIa inhibitors. Further prospective studies are warranted to confirm this association.

Original languageEnglish
Article number107438
JournalJournal of Stroke and Cerebrovascular Diseases
Volume32
Issue number12
DOIs
StatePublished - Dec 2023

Keywords

  • Antiplatelet
  • Stenting
  • Stroke
  • Thrombectomy

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