Preliminary Experience with Cangrelor for Endovascular Treatment of Challenging Intracranial Aneurysms View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-07-15

AUTHORS

Lamine Abdennour, Nader Sourour, Mehdi Drir, Kévin Premat, Eimad Shotar, Guillaume Taylor, Anne Godier, Jugurtha Mathout, Stéphanie Lenck, Remy Bernard, Alexandre Carpentier, Vincent Degos, Frédéric Clarençon

ABSTRACT

Background and PurposeCangrelor is a P2Y12 inhibitor that presents the advantage of having a short half-life. Its use may be helpful in the management of antiplatelet therapy for patients with intracranial aneurysms treated by stent-assisted coiling or flow-diverter stents. The purpose of this study was to report early experiences in using cangrelor for such indications.Material and MethodsFrom October 2017 to November 2018, 7 consecutive patients (5 females, 2 males, mean age = 56 years) were managed with cangrelor as antiplatelet therapy, combined with aspirin, for stent-assisted coiling embolization and flow-diverter embolization of challenging intracranial aneurysms. Anti-aggregation protocols, including cangrelor, were systematically recorded. Treatment-related complications (minor/major hemorrhagic complications, ischemic complications) as well as clinical and angiographic outcomes (evaluated at 8.7 ± 4.2 and 8.75 ± 10 months, respectively) were retrospectively analyzed.ResultsOf the aneurysms 71.4% (5 out of 7) were ruptured and treated in the acute phase. In one case cangrelor was used as an alternative to clopidogrel in an asymptomatic hemorrhagic complication after stent-assisted coiling for better control of a possible worsening of the intracranial bleeding. Of the patients, 1 (14%) with a complex ruptured MCA aneurysm treated with a flow-diverter stent experienced a severe intracranial hemorrhage, which occurred after switching the cangrelor to ticagrelor and eventually led to death. No hemorrhagic complications under cangrelor were recorded for the six remaining patients. No mRS worsening was observed at discharge, except for the patient who died and six out of the seven patients had a mRS ≤2 at follow-up.ConclusionCangrelor is a new antiplatelet therapy with a P2Y12 inhibiting effect, with a rapid onset and offset of action, owing to its short half-life. This cases series presents a pilot experience with promising results in terms of antiplatelet management for challenging intracranial aneurysms treated by stent assisted coiling or flow-diverter stents. More... »

PAGES

453-461

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00062-019-00811-2

DOI

http://dx.doi.org/10.1007/s00062-019-00811-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1118020050

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/31309241


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21 schema:description Background and PurposeCangrelor is a P2Y12 inhibitor that presents the advantage of having a short half-life. Its use may be helpful in the management of antiplatelet therapy for patients with intracranial aneurysms treated by stent-assisted coiling or flow-diverter stents. The purpose of this study was to report early experiences in using cangrelor for such indications.Material and MethodsFrom October 2017 to November 2018, 7 consecutive patients (5 females, 2 males, mean age = 56 years) were managed with cangrelor as antiplatelet therapy, combined with aspirin, for stent-assisted coiling embolization and flow-diverter embolization of challenging intracranial aneurysms. Anti-aggregation protocols, including cangrelor, were systematically recorded. Treatment-related complications (minor/major hemorrhagic complications, ischemic complications) as well as clinical and angiographic outcomes (evaluated at 8.7 ± 4.2 and 8.75 ± 10 months, respectively) were retrospectively analyzed.ResultsOf the aneurysms 71.4% (5 out of 7) were ruptured and treated in the acute phase. In one case cangrelor was used as an alternative to clopidogrel in an asymptomatic hemorrhagic complication after stent-assisted coiling for better control of a possible worsening of the intracranial bleeding. Of the patients, 1 (14%) with a complex ruptured MCA aneurysm treated with a flow-diverter stent experienced a severe intracranial hemorrhage, which occurred after switching the cangrelor to ticagrelor and eventually led to death. No hemorrhagic complications under cangrelor were recorded for the six remaining patients. No mRS worsening was observed at discharge, except for the patient who died and six out of the seven patients had a mRS ≤2 at follow-up.ConclusionCangrelor is a new antiplatelet therapy with a P2Y12 inhibiting effect, with a rapid onset and offset of action, owing to its short half-life. This cases series presents a pilot experience with promising results in terms of antiplatelet management for challenging intracranial aneurysms treated by stent assisted coiling or flow-diverter stents.
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29 MRS
30 P2Y12
31 P2Y12 inhibitors
32 action
33 acute phase
34 advantages
35 alternative
36 aneurysms
37 angiographic outcomes
38 antiplatelet management
39 antiplatelet therapy
40 aspirin
41 assisted coiling
42 asymptomatic hemorrhagic complications
43 background
44 better control
45 bleeding
46 cangrelor
47 clopidogrel
48 coiling
49 complexes
50 complications
51 consecutive patients
52 control
53 death
54 discharge
55 early experience
56 effect
57 embolization
58 endovascular treatment
59 experience
60 flow diverter stents
61 hemorrhage
62 hemorrhagic complications
63 indications
64 inhibitors
65 intracranial aneurysms
66 intracranial bleeding
67 intracranial hemorrhage
68 management
69 materials
70 new antiplatelet therapies
71 offset
72 offset of action
73 onset
74 outcomes
75 patients
76 phase
77 pilot experience
78 possible worsening
79 preliminary experience
80 promising results
81 protocol
82 purpose
83 rapid onset
84 results
85 series
86 severe intracranial hemorrhage
87 stent-assisted coiling
88 stent-assisted coiling embolization
89 stents
90 study
91 such indications
92 terms
93 therapy
94 ticagrelor
95 treatment
96 treatment-related complications
97 use
98 worsening
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