Background: Cangrelor, an intravenous P2Y12-receptor inhibitor, is a reversible and short-acting antithrombotic medication non-inferior to irreversible Glycoprotein IIb-IIIa inhibitors (GPI) like eptifibatide. However, there is insufficient data to compare the medications in endovascular thrombectomy (EVT) cases requiring emergent platelet inhibition. This study reviews our experience with cangrelor in EVT and compares its safety and efficacy against GPIs. Methods: A large healthcare system retrospective review identified all patients who received cangrelor or eptifibatide intraoperatively during EVT from December 2018 to March 2023 for a cohort study. Clinical data was reviewed. Functional status was defined by the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) at multiple time points. Binary variables were tested with Pearson ?2 tests or Fisher?s exact tests. Continuous variables were tested with two-tailed t-tests or Wilcoxon tests. Results: Of 1,010 EVT patients, 36 cangrelor and 104 eptifibatide patients were selected. There were no significant differences in baseline functional status or presentations. Cangrelor was most frequently administered for stenting tandem occlusions (n=16, 44.4%) and successful reperfusion occurred in 93.3% of patients (n=30). On multivariate analysis, cangrelor usage was associated with decreased odds of hemorrhagic conversion (adjusted odds ratio (AOR) 0.76, p=0.004) and symptomatic hemorrhage (AOR 0.86, p=0.021). There were no significant differences in thrombotic re-occlusion. Cangrelor was associated with lower 24-hour NIHSS (7.0 vs. 12.0, p=0.013) and discharge NIHSS scores (3.0 vs 9.0, p=0.009). There were no significant differences in in-hospital mortality or length of stay. Cangrelor was associated with improved odds of favorable outcome, defined as mRS 0-2, at discharge (AOR 2.69, p=0.001) and on 90-day follow-up (AOR 2.23, p=0.031). Conclusion: Cangrelor was associated with a decreased risk of hemorrhagic conversion and may lead to favorable functional outcomes for patients during hospitalization when compared to GPIs. Future prospective studies are warranted to investigate its use in EVT.

The authors have declared no competing interest.

No external funding was received for this study.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This retrospective study was approved by the Icahn School of Medicine at Mount Sinai Institutional Review Board (IRB) under STUDY# IRB-19-02829.

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The corresponding (AD) and senior author (HS) had full access to all data collected and analyzed in the study, and take responsibility for its analysis and integrity. Data may be made available at reasonable request.