Intravenous cangrelor as rescue therapy for acute thrombosis in neuroendovascular procedures: illustrative cases

BACKGROUND: Clot formation can lead to serious complications associated with endovascular procedures. Cangrelor, a novel intravenous (IV) antiplatelet medication, has been FDA approved for percutaneous coronary intervention. However, the use of cangrelor for the purpose of rescue therapy in neurovascular procedures has not been established. OBSERVATIONS: At the authors' institution, 4 patients received IV cangrelor for emergency thrombolysis during cerebral aneurysm embolization. In 3 cases, thrombus resolution was observed within minutes of cangrelor administration, restoring normal flow. In 1 case, cangrelor facilitated partial thrombolysis in conjuction with mechanical thrombectomy. No patient experienced an ischemic stroke or hemorrhagic complication. All patients were discharged home at their neurological baseline. Follow-up demonstrated no recurrent thrombosis or aneurysm recurrence. LESSONS: In this limited series, cangrelor was found to be a safe and effective IV platelet inhibitor with emergency thrombolysis capability after cerebral aneurysm embolization. Cangrelor is an attractive rescue agent due to its rapid onset, reversible P2Y12 inhibition, and extremely short half-life (on/off effect). https://thejns.org/doi/10.3171/CASE25930.