Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Department of Pharmacy, Albany Medical Center, Albany, NY, USA.
Interv Neuroradiol. 2021 Feb;27(1):88-98. doi: 10.1177/1591019920936923. Epub 2020 Jul 1.
Optimal antiplatelet inhibition is vital during cerebrovascular stenting procedures, yet no standardized recommendation exists for antithrombotic therapy in these scenarios. Cangrelor is an intravenous P2Y12 inhibitor with a favorable pharmacokinetic profile for use during neuroendovascular stenting.
A retrospective review of all neuroendovascular patients who underwent stenting between 1 January 2019 and 22 March 2020 and were treated with cangrelor was conducted. Thirty-seven patients met inclusion criteria.
All patients were administered a bolus of 5 mcg/kg of cangrelor followed by a maintenance infusion. Antiplatelet effects of cangrelor were monitored using platelet reactivity units (PRU). Based on the initial PRU, seven patients' doses were adjusted with subsequent PRUs in or near the goal range of 50-150. One patient experienced an acute intraprocedural occlusion likely related to a subtherapeutic PRU which subsequently resolved with cangrelor dose adjustment and intra-arterial tirofiban administration, and one patient experienced a post-procedure stent occlusion which required a thrombectomy and intra-arterial tirofiban administration. No hemorrhagic complications occurred.
Cangrelor utilization during neuroendovascular stenting with maintenance doses of <2 mcg/kg/min with dose adjustments based on platelet function testing has not been previously described. Cangrelor presents many advantages compared to standard therapy in patients undergoing stent placement related to its pharmacokinetic profile, rapid onset of action, ease of transition to oral P2Y antiplatelet agents, and measurability.
Cangrelor is a promising alternative to currently available therapies, especially in patients with a high hemorrhagic risk.
在脑血管支架置入术中，最佳的抗血小板抑制至关重要，但目前尚不存在针对此类情况的抗血栓治疗标准化推荐。坎格雷洛是一种静脉内 P2Y12 抑制剂，其药代动力学特征有利于在神经血管支架置入术中使用。
对 2019 年 1 月 1 日至 2020 年 3 月 22 日期间接受支架置入术且使用坎格雷洛治疗的所有神经介入患者进行回顾性分析。符合纳入标准的患者共 37 例。
所有患者均给予 5μg/kg 的坎格雷洛负荷剂量，随后给予维持输注。通过血小板反应单位（PRU）监测坎格雷洛的抗血小板作用。根据初始 PRU，有 7 例患者的剂量根据后续 PRU 进行了调整，使其接近 50-150 的目标范围。1 例患者术中出现急性闭塞，可能与亚治疗性 PRU 相关，经调整坎格雷洛剂量和给予动脉内替罗非班后，闭塞得以缓解，1 例患者术后支架闭塞，需要进行血栓切除术和动脉内替罗非班治疗。未发生出血性并发症。
在神经血管支架置入术中使用维持剂量<2μg/kg/min 的坎格雷洛，根据血小板功能检测结果调整剂量，这在以前尚未描述过。与标准治疗相比，坎格雷洛具有许多优势，尤其是在接受支架置入术的高出血风险患者中，其药代动力学特征、起效迅速、易于转为口服 P2Y 抗血小板药物、可测量性等特点使其具有吸引力。
坎格雷洛是目前可用治疗方法的一种有前途的替代方法，尤其是在高出血风险患者中。
