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Figures
- FIG 1.
Illustrative case 1. A and B, A 67-year-old patient who presented with a rapidly progressive coma associated with a right hemiplegia. Initial MR imaging demonstrates a basilar artery occlusion with a relatively small infarct core (posteriori circulation posterior circulation-ASPECTS = 8). The patient underwent intravenous thrombolysis combined with endovascular treatment. Considering the absence of recanalization of the basilar artery after 2 mechanical thrombectomy passes with a standard approach (C and D), intracranial angioplasty associated with cangrelor intravenous infusion was performed, allowing complete reperfusion (E). Day 1 MR imaging shows stability of the cerebellar infarction and patency of basilar artery without intracranial hemorrhage (F–H). The patient progressively recovered, and after 3 months, the mRS score was 0.
- FIG 2.
Illustrative case 2. A and B, This 81-year-old woman had acute left hemiparesis and dysarthria (initial NIHSS score = 8) secondary to an occlusion of the right M1 segment of the MCA, likely due to an underlying intracranial stenosis. Intravenous thrombolysis and endovascular treatment were performed. C, The first angiographic run confirms the pattern of intracranial acute thrombosis associated with an underlying stenosis (intracranial atherosclerosis). D, Considering the poor expected efficacy of a standard mechanical thrombectomy in such occlusion etiology, the limited infarct core, and the absence of intracranial hemorrhage at baseline, intracranial angioplasty and stent placement combined with cangrelor intravenous administration were performed as a first-line strategy. E and F, Clinical evolution and day 1 imaging have favorable results. At 90 days, the mRS score was 2.
- FIG 3.
Distribution of mRS scores at 90 days according to the antiplatelet therapy type.
Tables
GPIIb/IIIa Inhibitors (n = 54) Cangrelor (n = 15) Total (n = 69) P Value Arterial occlusion lesion score 2–3 44/54 (81.5%) 15/15 (100.0%) 59/69 (85.5%) .071 Final mTICI 2b-3 39/54 (75.0%) 14/15 (93.3%) 53/69 (79.1%) .124 Final mTICI 2c-3 16/52 (30.8%) 12/15 (80.0%) 28/67 (41.8%) <.001 Final mTICI 3 11/52 (21.2%) 7/15 (46.7%) 18/67 (26.9%) .050 Puncture-to-recanalization delay (median) (IQR) 80 (55−133) 107 (82–149) 87 (58–135) .573 Perioperative complication 11/54 (20.4%) 1/15 (6.7%) 12/69 (17.4%) .215 Day 1 NIHSS (median) (IQR)a 12 (7–16) 11 (5–16) 12 (6–16) .462 Day 1 ASPECTS (median) (IQR) 6 (4–7) 7 (6–8) 6 (4–7) .089 Intracranial artery patency on day 1 imaging follow-up 42/54 (79.2%) 13/15 (86.7%) 55/69 (80.9%) .519 Any ICH 20/54 (37.0%) 4/15 (26.7%) 24/69 (34.8%) .456 sICH 0/53 (0.0%) 1/15 (6.7%) 1 /68 (1.5%) .058 ECASS hemorrhage subtypes .798 HI-1 8/53 (15.1%) 2/15 (13.3%) 10/68 (14.7%) HI-2 7/53 (13.2%) 1/15 (6.7%) 8/68 (11.8%) PH-1 1/53 (1.9%) 1/15 (6.7%) 2/68 (2.9%) PH-2 0/53 (0%) 0/15 (0%) 0/69 (0%) Remote ICH 1/53 (1.9%) 0/15 (0.0%) 1/68 (1.5%) Subarachnoid hemorrhage 2/53 (3.8%) 0/15 (0.0%) 2/68 (2.9%) 90-Day mRS 0–2 17/54 (31.5%) 6/15 (40.0%) 23/69 (33.3%) .536 90-Day mortality 16/54 (29.6%) 3/15 (20.0%) 19/69 (27.5%) .460 Note:—IQR indicates interquartile range; HI-1, hemorrhagic infarction type 1; HI-2, hemorrhagic infarction type 2; PH-1, parenchymal hematoma type 1; PH-2, parenchymal hematoma type 2.
↵a Missing values in 26 patients.
GPIIb/IIIa Inhibitor Cangrelor Adjusted ORsa 95% CI P Value 90-Day mRS 0–2 31.5% 40.0% 2.22 0.42–11.75 .348 90-Day mortality 29.6% 20.0% 0.44 0.06–3.16 .411 Any ICH 37.0% 26.7% 0.40 0.08–2.09 .280 Final mTICI 2b–3 75.0% 93.3% 10.88 0.96–123.84 .054 Final mTICI 2c, 3 30.8% 80.0% 5.33 0.97–29.38 .055 Final mTICI 3 21.2% 46.7% 2.77 0.59– 13.02 .198 ↵a Adjusted for age, initial NIHSS score, initial ASPECTS, infarct topography (anterior versus posterior circulation), aspirin administration, and rescue intracranial stent placement.
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