학술논문
Low dose intravenous cangrelor versus glycoprotein IIb/IIIa inhibitors in endovascular treatment of tandem lesions.
Document Type
Academic Journal
Author
Jumaa MA; Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.; Rodriguez-Calienes A; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru.; Dawod G; Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.; Vivanco-Suarez J; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.; Hassan AE; Department of Neurology, Valley Baptist Medical Center / University of Texas Rio Grande Valley, Harlingen, TX, USA.; Divani AA; Department of Neurology, University of New Mexico Health Science Center, Albuquerque, NM, USA.; Oliver M; Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.; Ribo M; Department of Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain.; Petersen N; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.; Abraham M; Department of Neurology, University of Kansas Medical Center, KS, USA.; Fifi J; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Guerrero WR; Department of Neurology and Brain Repair, University of South Florida, Tampa, FL, USA.; Malik AM; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.; Siegler JE; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA.; Nguyen T; Department of Neurology, Boston Medical Center, Boston, USA.; Sheth S; Department of Neurology, UT Health McGovern Medical School, Houston, TX, USA.; Yoo A; Department of Neurology, Texas Stroke Institute, Plano, TX, USA.; Linares G; Department of Neurology, Saint Louis University, St. Louis, MO, USA.; Janjua N; Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, Pomona, CA.; Quispe-Orozco D; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.; Galecio-Castillo M; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.; Zevallos C; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.; Malaga M; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.; Farooqui M; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.; Jovin T; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA.; Zaidi S; Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.; Ortega-Gutierrez S; Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. Electronic address: santy-ortega@uiowa.edu.
Source
Publisher: Saunders Country of Publication: United States NLM ID: 9111633 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8511 (Electronic) Linking ISSN: 10523057 NLM ISO Abbreviation: J Stroke Cerebrovasc Dis Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: 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).
Materials and Methods: 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).
Results: 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).
Conclusions: 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.
Competing Interests: Declaration of Competing Interest Santiago Ortega-Gutierrez is consultant for Medtronic and Stryker. Afshin Divani received the following fundings: the University of New Mexico Center for Brain Recovery and Repair Center of Biomedical Research Excellence through Grant Number (NIH P20GM109089, Pilot PI), W81XWH-17-2-0053 (PI), 1R21NS130423-01 (PI). James Siegler reports receiving support from AstraZeneca (speakers bureau), unrelated to the present work. Sunil Sheth reports from the NIH (5R01 NS121154), as well as consulting fees from Penumbra, Imperative Care and Viz.AI. Ameer Hassan - 1.Consultant/Speaker: Medtronic, Microvention, Stryker, Penumbra, Cerenovus, Genentech, GE Healthcare, Scientia, Balt, Viz.ai, Insera therapeutics, Proximie, NeuroVasc, NovaSignal, Vesalio, Rapid Medical, Imperative Care and Galaxy Therapeutics; Principal Investigator: COMPLETE study – Penumbra, LVO SYNCHRONISE – Viz.ai, Millipede Stroke Trial - Perfuze, RESCUE - ICAD – Medtronic; Steering Committee/Publication committee member: SELECT, DAWN, SELECT 2, EXPEDITE II, EMBOLISE, CLEAR, ENVI, DELPHI, DISTALS; DSMB - COMAND trial; Michael Abraham is a consultant/speaker for Stryker Neurovascular. The rest of the authors report no conflicts.
(Copyright © 2023. Published by Elsevier Inc.)
Materials and Methods: 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).
Results: 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).
Conclusions: 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.
Competing Interests: Declaration of Competing Interest Santiago Ortega-Gutierrez is consultant for Medtronic and Stryker. Afshin Divani received the following fundings: the University of New Mexico Center for Brain Recovery and Repair Center of Biomedical Research Excellence through Grant Number (NIH P20GM109089, Pilot PI), W81XWH-17-2-0053 (PI), 1R21NS130423-01 (PI). James Siegler reports receiving support from AstraZeneca (speakers bureau), unrelated to the present work. Sunil Sheth reports from the NIH (5R01 NS121154), as well as consulting fees from Penumbra, Imperative Care and Viz.AI. Ameer Hassan - 1.Consultant/Speaker: Medtronic, Microvention, Stryker, Penumbra, Cerenovus, Genentech, GE Healthcare, Scientia, Balt, Viz.ai, Insera therapeutics, Proximie, NeuroVasc, NovaSignal, Vesalio, Rapid Medical, Imperative Care and Galaxy Therapeutics; Principal Investigator: COMPLETE study – Penumbra, LVO SYNCHRONISE – Viz.ai, Millipede Stroke Trial - Perfuze, RESCUE - ICAD – Medtronic; Steering Committee/Publication committee member: SELECT, DAWN, SELECT 2, EXPEDITE II, EMBOLISE, CLEAR, ENVI, DELPHI, DISTALS; DSMB - COMAND trial; Michael Abraham is a consultant/speaker for Stryker Neurovascular. The rest of the authors report no conflicts.
(Copyright © 2023. Published by Elsevier Inc.)