Full dose of cangrelor in the acute treatment of small ruptured cerebral aneurysms with flow diverters: a single center experience

Purpose: This article aims to retrospectively assess the safety, efficacy and feasibility of using intravenous cangrelor in the acute treatment of small ruptured cerebral aneurysms (less than 6 mm) with FD, discussing its potential advantages over traditional antiplatelet agents and its implication on clinical practice. Methods: This is a single-center retrospective study conducted on patients who underwent emergency FD implantation for hemorrhagic stroke due to acute rupture of intracranial aneurysms between January 2020 and February 2024. Patients were medicated with cangrelor in association with acetylsalicylic acid (ASA) before stent deployment. All patients were treated within 5 h from hospital arrival and received intravenous cangrelor (30 µg/kg administered over less than 1 min) + ASA (300 mg), followed by an infusion of cangrelor at 4 µg/kg/minute for either 12 or 24 h, as per clinical scenario. Procedural complications related to antiplatelet therapy itself, rate of complete aneurysm occlusion at 12-months follow-up and clinical outcome in terms of functional scale (mRS) were evaluated. Results: Ten patients were retrospectively evaluated. The interventions showed a favorable outcome with no reported thromboembolic or hemorrhagic complications within the first 24 h post-procedure. Six out of ten patients (60%) of patients had a good clinical prognosis (mRS 0-2), and MRA/CTA follow-ups indicated a complete resolution of aneurysms in the majority of cases (five out of seven patients (71.5%) occlusion rate at 12 months). Conclusion: In our limited experience, cangrelor has proven to be safe and effective in preventing thromboembolic complications after acute FD implantation for ruptured intracranial aneurysms; further studies with larger populations and comparative methodologies are required to incorporate cangrelor into standard neurovascular practice.