Intraprocedural cangrelor during mechanical thrombectomy for acute ischemic stroke: a systematic review and single-arm meta-analysis.
João Vitor Andrade Fernandes, João Victor de Oliveira Ramos, Maurus Marques de Almeida Holanda
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In 30 seconds
This systematic review and single-arm meta-analysis assessed intraprocedural intravenous cangrelor during mechanical thrombectomy in adults with acute ischemic stroke. Five prospective or retrospective studies comprising 131 patients were included. The pooled rate of successful reperfusion was 96.8% (95% CI: 0.894-0.991), while favorable functional outcome at 90 days (mRS 0-2) was 0.525 (95% CI: 0.286-0.753). Symptomatic intracranial hemorrhage occurred in 9.4% (95% CI: 0.049-0.173), and 90-day mortality was 30.9% (95% CI: 0.179-0.480).
Key findings
- Successful reperfusion was achieved in 96.8% (95% CI: 0.894-0.991), with no observed heterogeneity (I 2 = 0%).
- Favorable functional outcome at 90 days (mRS 0-2) had a pooled rate of 0.525 (95% CI: 0.286-0.753; I 2 = 68.9%).
- Symptomatic intracranial hemorrhage occurred in 9.4% (95% CI: 0.049-0.173); hemorrhagic transformation occurred in 26.6% (95% CI: 0.168-0.395).
- Ninety-day mortality was 30.9% (95% CI: 0.179-0.480); pooled in-stent thrombosis and thromboembolic event rates were 2.0% and 3.8%, respectively.
Why it matters
The pooled findings describe procedural success and clinically important safety outcomes when cangrelor is used during thrombectomy, including intracranial bleeding and mortality. They may help frame assessment of this intraprocedural antiplatelet approach, but the estimates come from a small evidence base and do not establish comparative benefit or harm.
What to keep in mind
Only five studies and 131 patients were included, and the single-arm meta-analysis provides no comparator for estimating cangrelor's relative effects. Functional outcome estimates showed substantial heterogeneity (I 2 = 68.9%).