Predictors of Hemorrhagic Transformation After IV Continuous Cangrelor Infusion Initiated During Mechanical Thrombectomy
14 affiliations
- 1Interventional Neuroradiology Department (A.G., A.F.v.S., B.M., M.P., R.B., S.E., W.B., A.A.R., H.R., S.S., E.R., H.B., M.M., J.-P.D., F.D.), Rothschild Foundation Hospital, Paris, France.
- 2Interventional Neuroradiology Department (A.G.), Pierre Wertheimer Hospital, Bron, France.
- 3CREATIS Laboratory, INSERM U1294, Claude Bernard Lyon I University, Villeurbanne, France (A.G., A.B.S.).
- 4Neurology Department, Foch Hospital, Suresnes, France (D.W.-L.).
- 5GIGA Cardiovascular, University of Liège, Belgium (M.A., F.D.).
- 6Biostatistics and Research Methods Centre (B-STAT), CHU de Liège and University of Liège, Belgium (M.E.).
- 7Stroke-Link, F-CRIN Research Infrastructure, Paris, France (B.M., M.M., J.-P.D., F.D.).
- 8Neurology Department (P.S.), Rothschild Foundation Hospital, Paris, France.
- 9Neuro-Intensive Care Unit, Rothschild Foundation Hospital, Paris, France (N.E.).
- 10Anesthesiology Department (S.C.), Rothschild Foundation Hospital, Paris, France.
- 11Université Paris-Cité, U1144 INSERM, Therapeutic optimization in Neuropsychopharmacology, France (B.H.-T.-N., M.M., J.-P.D.).
- 12Neurology Department, University Hospital of Toulouse, France (J.-M.O.).
- 13Neuroradiology Department (A.B.-S.), Pierre Wertheimer Hospital, Bron, France.
- 14Neurology Department, CHU Sart-Tilman, Liège, Belgium (F.D.).
Abstract
Background
Cangrelor, a fast-acting intravenous P2Y12 receptor inhibitor, is increasingly used during mechanical thrombectomy for acute ischemic stroke to treat or prevent thrombotic complications. While effective, its use may increase the risk of hemorrhagic transformation (HT). We investigated clinical, imaging, and procedural predictors of HT in this specific patient population.Methods
We performed a retrospective post hoc single-center study including 101 patients with acute ischemic stroke treated with intravenous cangrelor initiated directly after mechanical thrombectomy and continued for 12 hours between January 2021 and June 2024. Univariate and multivariable logistic regression models were used to assess associations between HT and clinical, radiological, and procedural factors.Results
Among the 101 patients included, 25 (24.7%) developed HT, and 9 (8.9%) experienced symptomatic intracerebral hemorrhage. In multivariable analysis, baseline blood glucose (adjusted odds ratio, 6.51 [95% CI, 1.35-31.4]; P=0.02), leukocytosis (adjusted odds ratio, 1.18 [95% CI, 1.00-1.38]; P=0.047), and subarachnoid hemorrhage on postmechanical thrombectomy cone-beam computed tomography (adjusted odds ratio, 16.60 [95% CI, 2.97-92.8]; P=0.0014) were independent predictors of HT. Contrast enhancement was associated with HT in univariate analysis but did not remain significant after adjustment.Conclusions
Baseline blood glucose, leukocytosis, and isolated subarachnoid hemorrhage on postmechanical thrombectomy cone-beam computed tomography emerged as independent predictors of HT. Identifying high-risk patients using readily available clinical and imaging markers may support individualized antiplatelet strategies and help reduce hemorrhagic complications during cangrelor treatment.Registration
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03776877.
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BibTeX
@article{gambino2026predictors,
title = {{Predictors of Hemorrhagic Transformation After IV Continuous Cangrelor Infusion Initiated During Mechanical Thrombectomy}},
author = {Andrea Gambino and David Weisenburger-Lile and Aurélien Freiherr von Seckendorff and Manar Abomulay and Marie Ernst and Benjamin Maïer and Pierre Seners and Michel Piotin and Raphaël Blanc and Simon Escalard and William Boisseau and Amira Al Raaisi and Hocine Redjem and Stanislas Smajda and Erwan Robichon and Humain Baharvahdat and Nicolas Engrand and Simon Clariot and Benoit Ho-Tin-Noé and Jean-Marc Olivot and Alexandre Bani-Sadr and Mikael Mazighi and Jean-Philippe Désilles and François Delvoye},
journal = {Stroke (Hoboken, N.J.)},
year = {2026},
month = sep,
doi = {10.1161/svin.126.002475},
url = {https://europepmc.org/article/PMC/PMC13727233},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Predictors of Hemorrhagic Transformation After IV Continuous Cangrelor Infusion Initiated During Mechanical Thrombectomy
AU - Andrea Gambino
AU - David Weisenburger-Lile
AU - Aurélien Freiherr von Seckendorff
AU - Manar Abomulay
AU - Marie Ernst
AU - Benjamin Maïer
AU - Pierre Seners
AU - Michel Piotin
AU - Raphaël Blanc
AU - Simon Escalard
AU - William Boisseau
AU - Amira Al Raaisi
AU - Hocine Redjem
AU - Stanislas Smajda
AU - Erwan Robichon
AU - Humain Baharvahdat
AU - Nicolas Engrand
AU - Simon Clariot
AU - Benoit Ho-Tin-Noé
AU - Jean-Marc Olivot
AU - Alexandre Bani-Sadr
AU - Mikael Mazighi
AU - Jean-Philippe Désilles
AU - François Delvoye
PY - 2026
DA - 2026/09/17
JO - Stroke (Hoboken, N.J.)
DO - 10.1161/svin.126.002475
UR - https://europepmc.org/article/PMC/PMC13727233
AB - Background Cangrelor, a fast-acting intravenous P2Y12 receptor inhibitor, is increasingly used during mechanical thrombectomy for acute ischemic stroke to treat or prevent thrombotic complications. While effective, its use may increase the risk of hemorrhagic transformation (HT). We investigated clinical, imaging, and procedural predictors of HT in this specific patient population.Methods We performed a retrospective post hoc single-center study including 101 patients with acute ischemic stroke treated with intravenous cangrelor initiated directly after mechanical thrombectomy and continued for 12 hours between January 2021 and June 2024. Univariate and multivariable logistic regression models were used to assess associations between HT and clinical, radiological, and procedural factors.Results Among the 101 patients included, 25 (24.7%) developed HT, and 9 (8.9%) experienced symptomatic intracerebral hemorrhage. In multivariable analysis, baseline blood glucose (adjusted odds ratio, 6.51 [95% CI, 1.35-31.4]; P=0.02), leukocytosis (adjusted odds ratio, 1.18 [95% CI, 1.00-1.38]; P=0.047), and subarachnoid hemorrhage on postmechanical thrombectomy cone-beam computed tomography (adjusted odds ratio, 16.60 [95% CI, 2.97-92.8]; P=0.0014) were independent predictors of HT. Contrast enhancement was associated with HT in univariate analysis but did not remain significant after adjustment.Conclusions Baseline blood glucose, leukocytosis, and isolated subarachnoid hemorrhage on postmechanical thrombectomy cone-beam computed tomography emerged as independent predictors of HT. Identifying high-risk patients using readily available clinical and imaging markers may support individualized antiplatelet strategies and help reduce hemorrhagic complications during cangrelor treatment.Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03776877.
SN - 2694-5746
ER -