Ruptured blister-type cerebral aneurysm pathogenesis and treatment with flow diversion using a novel antiplatelet agent cangrelor

Abstract

Ruptured blister type aneurysms are challenging to treat, and the ideal treatment remains debated. Recently, endovascular procedures, particularly flow diversion, gained popularity in treating blister aneurysms; however, the need for dual antiplatelet therapy remains a significant concern. Cangrelor is a novel intravenous P2Y12 platelet receptor antagonist with reversible binding and rapid onset and offset of action. These characteristics are appealing for use in endovascular procedures and may mitigate some concerns associated with other P2Y12 receptor antagonists. In this manuscript, we present the case of a ruptured blister aneurysm to highlight features of pathogenesis relevant to clinical course and patient management, describe current treatment paradigms, and illustrate the benefits of cangrelor in neurosurgical patients. Previously studied exclusively in the cardiac literature, this is one of the first reports of the use of cangrelor in neuro-endovascular procedures. This is important as cangrelor has the potential for improving the safety of endovascular procedures, especially in patients where treatment is associated with high risks of intraprocedural bleeding or other complications that may require further intervention.

Keywords

• Blister-type aneurysm
• Flow diversion
• Cangrelor