[en] [en] BACKGROUND AND PURPOSE: Rescue endovascular and pharmacologic approaches are increasingly being adopted after recanalization failure of acute large-vessel occlusion strokes with mechanical thrombectomy, with encouraging results. The safety and efficacy of glycoprotein IIb/IIIa inhibitors in ischemic stroke have been investigated, though cangrelor, a recent intravenous P2Y12-receptor inhibitor with a rapid onset/offset of action and a short half-life, may be a valuable option. We compared the safety and efficacy of cangrelor with those of glycoprotein IIb/IIIa inhibitors for refractory occlusions.
MATERIALS AND METHODS: We performed a retrospective analysis of the ongoing prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke Registry in France between May 2012 and February 2020. Refractory intracranial occlusions of the anterior and posterior circulation were included and defined as recanalization failure of large-vessel occlusion stroke, perioperative target artery reocclusion, or high risk of early reocclusion related to an arterial wall lesion. The primary end point was a favorable outcome, defined as a 90-day mRS of 0-2. Secondary end points were reperfusion, intracranial hemorrhage, and procedural complications.
RESULTS: Among 69 patients, 15 were treated with cangrelor, and 54, with glycoprotein IIb/IIIa inhibitors. The favorable outcome (adjusted OR = 2.22; 95% CI, 0.42-11.75; P = .348) and mortality (adjusted OR = 0.44; 95% CI, 0.06-3.16; P = .411) rates were similar in both groups. There was no difference in the rates of any intracranial hemorrhage (adjusted OR = 0.40; 95% CI, 0.08-2.09; P = .280), symptomatic intracranial hemorrhage (6.7% versus 0.0%, P = .058), or procedural complications (6.7% versus 20.4%, P = .215). Reperfusion rates were higher in the cangrelor group, though the difference did not reach statistical significance (93.3% versus 75.0% for modified TICI 2b-3; adjusted OR =10.88; 95% CI, 0.96-123.84; P = .054).
CONCLUSIONS: Cangrelor seems to be as safe as glycoprotein IIb/IIIa inhibitors for managing refractory intracranial occlusion and leads to satisfactory brain reperfusion. Cangrelor is a promising agent in this setting, and additional studies are warranted to confirm our findings.
Disciplines :
Neurology
Author, co-author :
Marnat, Gaultier ; Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France gaultier.marnat@chu-bordeaux.fr
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
Finitsis, S ; Aristotle University of Thessaloniki (S.F.), Ahepa Hospital, Thessaloniki, Greece
Lapergue, Bertrand ; Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
Gariel, F ; Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
Consoli, A ; Department s of Neuroradiology (A.C.) and Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
Desilles, J-P ; Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
Mazighi, Mikael ; Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
Dargazanli, C ; Department of Neuroradiology (C.D.), Centre Hospitalier Régional Universitaire Gui de Chauliac, Montpellier, France
Bourcier, R ; Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
Darcourt, J ; Department of Neuroradiology (J.D.), University Hospital of Toulouse, Toulouse, France
Chalumeau, V ; Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
Elhorany, M ; Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
Clarençon, Frédéric ; Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
Richard, Sébastien ; Department of Neurology (S.R.), Université de Lorraine, Centre Hospitalier Régional Universitaire-Nancy, Stroke Unit, Nancy, France ; Institut national de la santé et de la recherche médicale U1116 (S.R.), Centre Hospitalier Régional Universitaire-Nancy, Nancy, France
Gory, B ; Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, CHRU-Nancy, Nancy, France ; Institut National de la Santé et de la Recherche Mmédicale U1254 (B.G.), Université de Lorraine, Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France
Sibon, I ; Neurology Department, Bordeaux University Hospital, Bordeaux, France
Disclosures: Gaultier Marnat—UNRELATED: Payment for Lectures Including Service on Speakers Bureaus: Medtronic, MicroVention. Bertrand Lapergue— UNRELATED: Grants/Grants Pending: MicroVention, Phenox.* Mikael Mazighi— UNRELATED: Consultancy: Air Liquide, Amgen, Boerhinger Ingelheim, Acticor Biotech; Grants/Grants Pending: RHU BOOSTER, Agence Nationale pour la Recherche, funding from French Ministry of Health.* Frédéric Clarençon— UNRELATED: Board Membership: ArteDrone; Consultancy: Medtronic; Payment for Lectures Including Service on Speakers Bureaus: Balt, Penumbra, Stryker. Sébastien Richard—UNRELATED: Grants/Grants Pending: French Ministry, Comments: grants for 2 academic studies*; Payment for Development of Educational Presentations: Boehringer Ingelheim. *Money paid to the institution.
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