Cangrelor for emergent carotid stenting during stroke thrombectomy: a comparative analysis versus glycoprotein IIb/IIIa inhibitors or aspirin monotherapy

Raoul Pop; Stephanos Nikolaos Finitsis; Gaultier Marnat; Imad Derraz; Christophe Cognard; Lionel Calviere; Jildaz Caroff; Frédéric Clarençon; François Delvoye; Arturo Consoli; Bertrand Lapergue; Benjamin Gory; ETIS Registry Investigators

doi:10.1136/jnis-2024-022125

Cangrelor for emergent carotid stenting during stroke thrombectomy: a comparative analysis versus glycoprotein IIb/IIIa inhibitors or aspirin monotherapy

J Neurointerv Surg. 2024 Sep 6:jnis-2024-022125. doi: 10.1136/jnis-2024-022125. Online ahead of print.

Authors

Raoul Pop^{1

2

3}, Stephanos Nikolaos Finitsis⁴, Gaultier Marnat⁵, Imad Derraz⁶, Christophe Cognard⁷, Lionel Calviere⁸, Jildaz Caroff⁹, Frédéric Clarençon^{10

11}, François Delvoye¹², Arturo Consoli¹³, Bertrand Lapergue¹⁴, Benjamin Gory^{15

16

17}; ETIS Registry Investigators

Affiliations

¹ Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France pop.raoul@gmail.com.
² Interventional Radiology, IHU Strasbourg, Strasbourg, France.
³ INSERM UMR_S1255, Etablissement Français du Sang, Strasbourg, France.
⁴ Department of Neuroradiology, Aristotle University of Thessaloniki, Thessalonike, Greece.
⁵ Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France.
⁶ Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
⁷ Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, France.
⁸ Stroke Unit, CHU Toulouse, Toulouse, France.
⁹ Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France.
¹⁰ Radiology, Sorbonne Universite, Paris, France.
¹¹ Neuroradiology, Hopital Universitaire Pitie-Salpetriere, Paris, France.
¹² Neurointerventional Radiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
¹³ Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France.
¹⁴ Neurology, Hospital Foch, Suresnes, France.
¹⁵ Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France.
¹⁶ Radiology, Université de Lorraine, Nancy, France.
¹⁷ IADI, INSERM U1254, Nancy, France.

PMID: 39242196
DOI: 10.1136/jnis-2024-022125

Abstract

Background: Periprocedural antiplatelet treatment is a key determinant for the risk-benefit balance of emergent carotid artery stenting (eCAS) during stroke endovascular treatment (EVT). We aimed to assess the safety and efficacy profile of cangrelor compared with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors or aspirin monotherapy.

Methods: Data were extracted from the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a prospective nationwide observational registry of stroke EVT in France. Included patients were treated with eCAS for anterior circulation tandem lesions between January 2015 and June 2023 and received periprocedural treatment with cangrelor, GPIIb/IIIa inhibitors or aspirin monotherapy. The primary outcome was functional outcome at 90 days, assessed by the modified Rankin Scale (mRS). Secondary outcomes included intracranial recanalization, hemorrhagic transformation and carotid stent patency at day 1.

Results: Of the 1687 patients treated, 384 met the inclusion criteria: 91 received cangrelor, 77 received GPIIb/IIIa inhibitors and 216 aspirin monotherapy. Cangrelor was associated with a negative shift in the distribution of mRS scores compared with GPIIb/IIIa inhibitors (aOR 0.48, 95% CI 0.25 to 0.94, P=0.033). Compared with aspirin, cangrelor improved carotid stent patency at day 1 (aOR 4.00, 95% CI 1.19 to 14.29, P=0.025) but showed no significant differences in clinical outcomes. There were no differences in outcomes between full dose and low dose cangrelor. GPIIb/IIIa inhibitors demonstrated higher odds of functional independence (aOR 2.56, 95% CI 1.08 to 6.25, P=0.033) compared with aspirin.

Conclusions: This registry-based study indicates a potential trend towards lower odds of favorable clinical outcomes with cangrelor treatment compared with GPIIb/IIIa inhibitors. However, these findings should be interpreted with caution due to potential selection bias and warrant further research for validation.

Keywords: Stenosis; Stent; Stroke; Thrombectomy.