(759) Cangrelor in Acute Stenting of Ruptured Aneurysms and Concomitant External Ventricular Drain Use

Introduction: Patients with ruptured aneurysms who need acute stenting pose unique risks when utilizing antiplatelet agents due to the need to balance the risk of rebleeding and thrombosis and the possibility of external ventricular drain (EVD) placement. Evidence for the safety cangrelor use in patients with ruptured aneurysms is limited.

Methods: A multi-center, retrospective, cohort study is being conducted at 12 centers in patients who underwent acute cerebrovascular stenting (ischemic stroke and aneurysm repair) between January 2018 and March 2024 and were treated with cangrelor. Ten centers contributed data for patients who had ruptured aneurysms with or without EVD placement. Relevant demographic, procedural, laboratory, EVD placement and outcome data were collected.

Results: A total of 56 patients had ruptured aneurysms repaired with stenting. Patients had an average Hunt and Hess score of 2 and all patients had one aneurysm repaired with most patients having one stent placed. Flow diverters were placed in most patients (31 [55%]) followed by stent-assisted coiling (19 [34%]). A total of 6 patients had thrombotic complications (3 intraprocedural and 3 post-procedure). Two patients had intraprocedural hemorrhage and 5 patients had post procedure intracranial hemorrhage (3 symptomatic, 2 asymptomatic). In an analysis of cangrelor dose (39 high-dose cangrelor [HDC; ≥ 2 mcg/kg/min] patients, 17 low-dose cangrelor [LDC; < 2 mcg/kg/min] patients) there was no difference in the rate of any thrombotic complications (3 patients on HDC, 3 patients on LDC; p>0.999). There was no difference in any bleeding complication between patients who received HDC vs LDC (5 [13%] vs 2 [12%], p > 0.999). Thirty-two patients had EVDs utilized while on cangrelor (19 patients were in ruptured aneurysm cohort) and most patients (81% [26]) were on cangrelor while an EVD was in place (cangrelor was not infusing during EVD placement or removal); two patients (6%) experienced tract hemorrhages.

Conclusions: Cangrelor use in patients with ruptured aneurysms is reasonably safe with a low rate of thrombotic or bleeding complications. Further study is needed to delineate the optimal dose of cangrelor in neuroendovascular stenting in patients with ruptured aneurysms.