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-Orozco; Milagros Galecio-Castillo; Cynthia Zevallos; Marco Malaga; Mudassir Farooqui; Tudor Jovin; Syed Zaidi; Santiago Ortega-Gutierrez

doi:10.1016/j.jstrokecerebrovasdis.2023.107438

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

Journal article

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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, …

Journal of stroke and cerebrovascular diseases, Vol.32(12), 107438

12/2023

DOI: 10.1016/j.jstrokecerebrovasdis.2023.107438

PMCID: PMC11271813

PMID: 37883826

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https://pmc.ncbi.nlm.nih.gov/articles/PMC11271813/pdf/nihms-2010925.pdfView

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Abstract

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). 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). 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). 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.

Stroke

Antiplatelet

Stenting

Thrombectomy

Details

Title: Subtitle: Low dose intravenous cangrelor versus glycoprotein IIb/IIIa inhibitors in endovascular treatment of tandem lesions
Creators: Mouhammad A. Jumaa - University of Toledo
Aaron Rodriguez-Calienes - University of Iowa
Giana Dawod - University of Toledo
Juan Vivanco-Suarez - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Ameer E. Hassan - The University of Texas Rio Grande Valley
Afshin A. Divani - University of New Mexico
Marion Oliver - University of Toledo
Marc Ribo - Department of Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
Nils Petersen - Yale University
Michael Abraham - University of Kansas Medical Center
Johanna Fifi - Icahn School of Medicine at Mount Sinai
Waldo R. Guerrero - Department of Neurology and Brain Repair, University of South Florida, Tampa, FL, USA
Amer M. Malik - University of Miami
James E. Siegler - Cooper University Hospital
Thanh Nguyen - Boston Medical Center
Sunil Sheth - Department of Neurology, UT Health McGovern Medical School, Houston, TX, USA
Albert Yoo - Department of Neurology, Texas Stroke Institute, Plano, TX, USA
Guillermo Linares - Saint Louis University
Nazli Janjua - Pomona Valley Hospital Medical Center
Darko Quispe-Orozco - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Milagros Galecio-Castillo - University of Iowa
Cynthia Zevallos - University of Iowa
Marco Malaga - University of Iowa
Mudassir Farooqui - University of Iowa
Tudor Jovin - Cooper University Hospital
Syed Zaidi - University of Toledo
Santiago Ortega-Gutierrez - Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Resource Type: Journal article
Publication Details: Journal of stroke and cerebrovascular diseases, Vol.32(12), 107438
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107438
PMID: 37883826
PMCID: PMC11271813
NLM abbreviation: J Stroke Cerebrovasc Dis
ISSN: 1052-3057
eISSN: 1532-8511
Publisher: Elsevier Inc
Language: English
Date published: 12/2023
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984500079602771

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