Pop Raoul, Finitsis Stephanos Nikolaos, Marnat Gaultier, Derraz Imad, Cognard Christophe, Calviere Lionel, Caroff Jildaz, Clarençon Frédéric, Delvoye François, Consoli Arturo, Lapergue Bertrand, Gory Benjamin
Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France
Interventional Radiology, IHU Strasbourg, Strasbourg, France.
J Neurointerv Surg. 2025 Jun 1;17(e2):e269-e275. doi: 10.1136/jnis-2024-022125.
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.
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.
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.
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.
围手术期抗血小板治疗是卒中血管内治疗（EVT）期间急诊颈动脉支架置入术（eCAS）风险效益平衡的关键决定因素。我们旨在评估坎格雷洛与糖蛋白IIb/IIIa（GPIIb/IIIa）抑制剂或阿司匹林单药治疗相比的安全性和疗效。
数据来自缺血性卒中血管内治疗（ETIS）注册研究，这是一项法国全国性前瞻性卒中EVT观察性注册研究。纳入的患者在2015年1月至2023年6月期间接受了eCAS治疗前循环串联病变，并接受了围手术期坎格雷洛、GPIIb/IIIa抑制剂或阿司匹林单药治疗。主要结局是90天时的功能结局，采用改良Rankin量表（mRS）评估。次要结局包括颅内再通、出血转化和第1天的颈动脉支架通畅情况。
在1687例接受治疗的患者中，384例符合纳入标准：91例接受坎格雷洛治疗，77例接受GPIIb/IIIa抑制剂治疗，216例接受阿司匹林单药治疗。与GPIIb/IIIa抑制剂相比，坎格雷洛与mRS评分分布的负向变化相关（调整后比值比[aOR]0.48，95%置信区间[CI]0.25至0.94，P = 0.033）。与阿司匹林相比，坎格雷洛在第1天改善了颈动脉支架通畅情况（aOR 4.00，95%CI 1.19至14.29，P = 0.025），但在临床结局方面无显著差异。全剂量和低剂量坎格雷洛之间的结局无差异。与阿司匹林相比，GPIIb/IIIa抑制剂显示出更高的功能独立几率（aOR 2.56，95%CI 1.08至6.25，P = 0.033）。
这项基于注册研究的结果表明，与GPIIb/IIIa抑制剂相比，坎格雷洛治疗的良好临床结局几率可能有降低趋势。然而，由于潜在的选择偏倚，这些发现应谨慎解释，需要进一步研究进行验证。
