Reperfusion with P2Y12 inhibitors in addition to mechanical thrombectomy for perfusion imaging selected acute stroke patients : a multicentric randomized controlled trial

Prior treatment

• Curative heparin or direct oral anticoagulants (DOACs) in previous 48 hours with specific DOAC dosage ≥50 ng/ml and abnormal thrombin time for patients on dabigatran or abnormal specific anti-Xa activity for patients on apixaban, edoxaban, or rivaroxaban
• History of previous intracranial hemorrhage

Other illness

• Known hypersensitivity to cangrelor or to any of the excipients (mannitol, sorbitol)
• Evidence of active bleeding or acute trauma (fracture) on examination
• Recent surgery with a significant risk of bleeding

Lab values

• VKA oral anticoagulation with INR >1.7
• Platelet count <100 000/ mm3
• Woman of childbearing age without a pregnancy test or with a positive serum pregnancy test

Age

• Patient over 80 years old with >10 microbleeds on pre-treatment MRI

Other

• Contraindication to MT
• Patient benefiting from a legal protection
• Non-membership of a national insurance scheme
• Opposition of the patient or (in case of inclusion as a matter of urgency) of the trustworthy person
• Participation in another study regarding AIS care interfering with this study
• Pre-existing dependency with mRS ≥3
• Known tandem ICA-MCA occlusions requiring stenting
• ASPECT<6 on NCCT or DWI-MRI

• Age 18 or older
• Anterior circulation intracanial large artery occlusion isolated (Intracranial ICA and/or MCA) proved on CTA or MRA
• Symptoms onset < 24h at imaging
• Indication for MT and fulfillment of the following brain imaging criteria : 1. Perfusion imaging: An initial infarct volume (ischemic core on DWI or CTP calculated by the RAPID software) of less than 70 ml, a ratio between the critically hypoperfused lesion volume (calculated by RAPID with a TMax>6s) and initial infarct volume of 1.8 or more, and an absolute difference between those 2 volumes of 15 ml or more. OR (if perfusion imaging not available or uninterpretable) : 2. CORE CLINICAL MISMATCH: Core calculated on DWI by RAPID, <25 mL if NIHSS 6-20 and <50 mL if NIHSS>20 OR (if RAPID results are not considered reliable by the clinician) : 3. CORE CLINICAL MISMATCH according to the clinician evaluation
• Pre-stroke mRS ≤ 2
• NIHSS ≥ 6