Use of intravenous cangrelor in the treatment of ruptured and unruptured cerebral aneurysms: an updated single-center analysis and pooled analysis of current studies.

Autor:	Entezami P; Neurosurgery, Albany Medical Center, Albany, New York, USA., Dalfino JC; Neurosurgery, Albany Medical Center, Albany, New York, USA., Boulos AS; Neurosurgery, Albany Medical Center, Albany, New York, USA., Yamamoto J; Neurosurgery, Albany Medical Center, Albany, New York, USA., Holden DN; Department of Pharmacy, Albany Medical Center, Albany, New York, USA., Field NC; Neurosurgery, Albany Medical Center, Albany, New York, USA., Rock AK; Neurosurgery, Albany Medical Center, Albany, New York, USA., Najera E; Neurosurgery, Albany Medical Center, Albany, New York, USA., Paul AR; Neurosurgery, Albany Medical Center, Albany, New York, USA PaulA1@amc.edu.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2023 Jul; Vol. 15 (7), pp. 669-673. Date of Electronic Publication: 2022 Jun 22.
DOI:	10.1136/neurintsurg-2022-018986
Abstrakt:	Background: Intracranial stent placement for the treatment of cerebral aneurysms is increasingly utilized in both ruptured and unruptured scenarios. Intravenous (IV) cangrelor is a relatively new antiplatelet agent that was initially approved for coronary interventions. In addition to our institution, five other centers have published their results using IV cangrelor in neurointerventional procedures. This article combines the aneurysm treatment data from all prior studies to provide insight into the safety and efficacy of cangrelor for intracranial aneurysm treatment. Methods: A prospectively maintained database was reviewed to identify all cases of IV cangrelor administration during aneurysm embolization. 20 additional patients were identified who had not been previously published. In addition, a literature search was performed to identify prior publications regarding cangrelor in neurointervention. The data from these were combined with our institutional results in a pooled-analysis. Results: Overall, 85 patients who received IV cangrelor during aneurysm embolization were identified, including 46 ruptured and 39 unruptured cases. The asymptomatic and symptomatic intracranial hemorrhage rates were 4% (2/46) for ruptured cases and 2.6% (1/39) for unruptured cases. The rate of retroperitoneal hematoma and gastrointestinal bleeding was 0%. There were no incidents of intraprocedural thromboembolic complication or intraprocedural in-stent thrombosis in either cohort. One subject suffered an ischemic stroke at 24 hours secondary to in-stent thrombosis in a ruptured case. Conclusions: IV cangrelor during aneurysm embolization appears to be safe, with a symptomatic intracranial hemorrhage rate of 4% in ruptured cases and 2.6% in unruptured cases. More research is needed to determine the ideal dosing regimen. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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