{
  "abstract": "Background Endovascular treatment (EVT) failures and early reocclusions in stroke often result from arterial wall disease, incomplete thrombus withdrawal, or acute endothelial injury. Intracranial and extracranial atherosclerosis, in particular, poses a risk of reocclusion, sometimes requiring tailored interventions (eg, angioplasty, stenting). While glycoprotein (GP) IIb/IIIa inhibitors have been widely studied in ischemic stroke, cangrelor remains less explored.Objective To evaluate the safety and efficacy of cangrelor compared with GPIIb/IIIa inhibitors in large vessel occlusion stroke (LVOS).Methods This retrospective analysis from the Endovascular Treatment in Ischemic Stroke Registry included patients from 34 French centers who received cangrelor or GPIIb/IIIa inhibitors during EVT between July 2018 and September 2023. Eligible cases had refractory occlusions or arterial disease at risk of reocclusion. The primary outcome was a 90-day favorable outcome. Secondary outcomes included excellent functional outcome, early neurological improvement, intracranial hemorrhage (ICH), procedural complications, and day 1 arterial patency. Propensity score overlap weighting was used for comparisons.Results Of 559 patients, 160 received GPIIb/IIIa inhibitors and 399 received cangrelor. Favorable outcomes were comparable (41.7% vs 43.7%; OR=1.1; 95% CI 0.61 to 1.93), as were rates of excellent functional outcome and early neurological improvement. Angiographic efficacy was similar, with modified Thrombolysis in Cerebral Infarction ≥2b rates of 89.5% for GPIIb/IIIa and 90.1% for cangrelor. No significant differences were observed in day 1 patency, 90-day mortality, or symptomatic ICH.Conclusions Cangrelor showed comparable safety and efficacy to GPIIb/IIIa inhibitors. These results, along with the specific pharmacodynamics, make this drug a promising agent in the acute management of complex intracranial and extracranial LVOS.Trial registration number NCT03776877.",
  "authors": [
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, CHU de Bordeaux Pôle d’imagerie médicale, Bordeaux, France"
      ],
      "name": "Małgorzata Milnerowicz"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France"
      ],
      "name": "Jean-Philippe Desilles"
    },
    {
      "affiliations": [
        "Department of Neuroradiolology, CHU de Strasbourg Pôle Imagerie, Strasbourg, France"
      ],
      "name": "Raoul Pop"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France"
      ],
      "name": "Cyril Dargazanli"
    },
    {
      "affiliations": [
        "Department of Biostatistics, Lille University Hospital, Lille, France"
      ],
      "name": "Julien Labreuche"
    },
    {
      "affiliations": [
        "Department of Neurology, CHU de Bordeaux, Talence, France"
      ],
      "name": "Igor Sibon"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Nancy University Hospital Center, Nancy, France"
      ],
      "name": "Benjamin Gory"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, CHU Reims Imagerie Médicale, Reims, France"
      ],
      "name": "Sébastien Soize"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Hospital Centre Nantes, Nantes, France"
      ],
      "name": "Romain Bourcier"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France"
      ],
      "name": "Mikael Mazighi"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Therapeutic Neuroradiology, University Hospital Centre Toulouse, Toulouse, France"
      ],
      "name": "Christophe Cognard"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, AP-HP Université Paris Saclay, Paris, France"
      ],
      "name": "Jildaz Caroff"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, CHRU de Brest, Brest, France"
      ],
      "name": "Jean Christophe Gentric"
    },
    {
      "affiliations": [
        "Sorbonne University, Paris, France",
        "Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France"
      ],
      "name": "Frédéric Clarençon"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Pau Hospital, Pau, France"
      ],
      "name": "Sebastian Richter"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Regional University Hospital Centre Tours Radiology Diagnostic and Interventional Neuroradiology, Tours, France"
      ],
      "name": "Kevin Janot"
    },
    {
      "affiliations": [
        "Hospital Foch Department of Therapeutic and Interventional Neuroradiology, Suresnes, France"
      ],
      "name": "Bertrand Lapergue"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, CHU de Bordeaux Pôle d’imagerie médicale, Bordeaux, France"
      ],
      "name": "Gaultier Marnat"
    },
    {
      "affiliations": [],
      "name": "on behalf of ETIS investigators"
    }
  ],
  "title": "Cangrelor versus GPIIb/IIIa inhibitors as adjunctive therapy in endovascular treatment of large vessel occlusion stroke",
  "uid": "d94678c1-30ba-5082-8db0-07741722d62f"
}