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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28 schema:keywords Anti-aggregation protocols
29 Challenging Intracranial Aneurysms
30 ConclusionCangrelor
31 MCA
32 MRS
33 P2Y12
34 P2Y12 inhibitors
35 PurposeCangrelor
36 action
37 acute phase
38 advantages
39 alternative
40 aneurysms
41 angiographic outcomes
42 antiplatelet management
43 antiplatelet therapy
44 aspirin
45 assisted coiling
46 asymptomatic hemorrhagic complications
47 background
48 better control
49 bleeding
50 cangrelor
51 case cangrelor
52 clopidogrel
53 coiling
54 coiling embolization
55 complexes
56 complications
57 consecutive patients
58 control
59 death
60 discharge
61 early experience
62 effect
63 embolization
64 endovascular treatment
65 experience
66 flow diverter stents
67 flow-diverter embolization
68 hemorrhage
69 hemorrhagic complications
70 indications
71 inhibitors
72 intracranial aneurysms
73 intracranial bleeding
74 intracranial hemorrhage
75 management
76 materials
77 new antiplatelet therapies
78 offset
79 offset of action
80 onset
81 outcomes
82 patients
83 phase
84 pilot experience
85 possible worsening
86 preliminary experience
87 promising results
88 protocol
89 purpose
90 rapid onset
91 results
92 series
93 severe intracranial hemorrhage
94 stent-assisted coiling
95 stent-assisted coiling embolization
96 stents
97 study
98 such indications
99 terms
100 therapy
101 ticagrelor
102 treatment
103 treatment-related complications
104 use
105 worsening
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