Abstract 117: Intravenous Cangrelor Use in Patients with Intracranial Hemorrhage

Introduction Cangrelor is an intravenous (IV), direct‐acting, and reversible P2Y12 inhibitor with rapid onset and offset. Hence, use of Cangrelor in cerebrovascular interventions has recently expanded. We report our experience with IV Cangrelor in patients with intracranial hemorrhage who required antiplatelet medication to avoid stent thrombosis. Methods We reviewed the available computed tomographic (CT) images before, during, and after completion of IV Cangrelor infusion to identify any increase in intracranial hemorrhage. We also ascertained any neurological deterioration (defined by increase in NIH stroke scale of ≥4 points) and occurrence of new thromboembolic events. Results Four patients we switched from oral P2Y12 inhibitors to IV Cangrelor due to new‐onset intracranial hemorrhage. Two patients had stents placed in cervical Internal Carotid Arteries during thrombectomy, one patient underwent stent placement in vertebral artery during thrombectomy, and one patient underwent stent assisted coiling for internal carotid artery aneurysm. Post‐procedural mean time to initiate IV Cangrelor infusion was 6 days (SD=7.6 days). All patients received a bolus of 5mcg/kg of Cangrelor followed by 1mcg/kg/min maintenance dose for a mean period of 5.8 days (SD=3.3 days). Serial CT scans of head were obtained after initiation of IV Cangrelor in 3 patients (mean number of scans was 3.7), None of the patients experienced either neurological deterioration or worsening of the intracranial hemorrhage during follow up. Three out of four patients underwent repeat vascular imaging, documenting no stent thrombosis or occlusion. Results Use of IV Cangrelor infusion appears to be safe in patients with intracranial hemorrhage in whom platelet inhibition is necessary to avoid stent thrombosis.