P168/276 Intravenous dose-adjusted cangrelor use for neuroendovascular procedures: an institutional experience

Introduction

The safety and feasibility of intravenous cangrelor use for neuroendovascular procedures needs to be investigated.

Aim of Study

To investigate safety and feasibility of intravenous dose-adjusted cangrelor in patients undergoing neuroendovascular procedures

Methods

We conducted a retrospective study on patients who underwent neuroendovascular procedures and were placed on intravenous cangrelor. Cangrelor was administered as a 15 mcg/kg bolus followed by 2 mcg/kg/min infusion titrated to goal P2Y₁₂ reaction unit (PRU) level of 50 to 150, then transitioned to oral antiplatelet therapy.

Results

A total of 67 patients were included (mean age (years): 57.8 ± 18.5, males: 34 (50.7%), Black: 51 (76.1%)). The most common comorbidity was hypertension (n=38/66, 56.7%). Six patients (9.0%) received intravenous thrombolysis. Cangrelor infusion was used for stent placement (n=21, 32.3%). Stenting occurred intracranially in 18 patients, extracranially in 22 patients, and both intracranial and carotid arteries in 3 patients. PRU levels were measured in 61 patients (91.0%). Approximately 40.9% of the patients had favorable outcomes with modified Rankin Scale (mRS) score of 0 to 2 at 90 days (n=18/44). Within 1-year, 4 patients had recurrent/new strokes (7.7%), 2 with symptomatic intracranial hemorrhage [sICH] (3.0%), 3 with asymptomatic intracranial hemorrhage [aICH] (4.5%), and 1 gastrointestinal bleeding event were recorded (1.5%). When stratified by supratherapeutic PRU level (PRU < 50), there was a difference in sICH (p=0.044) but not aICH (p=0.203).

Conclusion

This is the first report to demonstrate the safety and effectiveness of intravenous cangrelor use titrated by platelet function testing in neuroendovascular procedures.

Disclosure of Interest

The authors have nothing to disclose.