Abstract Body: Background: Increased immediate and delayed re-occlusion rates, up to 33%, are reported in patients undergoing acute stenting for tandem lesions, with symptomatic hemorrhage rates around 10-15%. Intraprocedural intravenous (IV) cangrelor is emerging as a bridging therapy for antiplatelet inhibition during acute stenting in ischemic stroke. We report our single-center experience with IV cangrelor in patients undergoing rescue stenting.
Methods: We conducted a retrospective analysis from a single-center large vessel occlusion registry from July 2015 to October 2023. Patients who underwent emergent stenting and received IV cangrelor (30 mcg/kg bolus, then 4 mcg/kg/min), followed by dual antiplatelet therapy upon achieving enteric access, were included. The primary outcome was re-occlusion of cervical or intracranial arteries, assessed immediately, early (within 24 hours), and at follow-up. Secondary outcomes included symptomatic hemorrhage or death (based on ECAS-III criteria) and early neurologic deterioration (defined as a change in NIHSS score of ≥4 within 24 hours). Continuous variables were summarized with means and standard deviations; categorical variables were presented as frequencies and percentages. T-tests compared continuous variables, while chi-square or Fisher’s exact tests analyzed categorical variables.
Results: Among 220 patients, 201 (91%) underwent cervical stenting, and 19 (9%) received intracranial stenting. The mean age was 68 years (SD ± 11.50), with a male predominance of 63%; 85% did not experience immediate, early, or delayed re-occlusion, a rate lower than previously reported. The symptomatic hemorrhage rate was 10.76%, consistent with prior literature. No significant differences in symptomatic hemorrhage were found between cervical and intracranial stenting groups (10% vs. 1%, p = 0.3) or between those with and without IV thrombolytics (11% vs. 10%, p = 0.80). Early neurologic deterioration occurred more frequently in the intracranial stenting group (33% vs. 17%, p = 0.23), though not statistically significant. At 90 days, favorable outcomes (mRS 0-2) were similar between the intracranial and cervical stenting groups (42% vs. 49%, p = 0.55).
Conclusion: IV cangrelor can be considered as a bridging therapy for antiplatelet inhibition during acute rescue stenting. Larger studies are needed to validate these findings.