The main objective is to evaluate the efficacy of IV administration of the P2Y12 inhibitor (cangrelor) in addition to mecanich thrombectomy and WMD versus mecanich thrombectomy and WMD alone on the functional prognosis at 3 months, in patients with acute ischemic stroke eligible for mecanich thrombectomy on the basis of infusion imaging between 0 and 24 hours after the onset of symptoms.
The emergent reperfusion of the ischemic penumbra is the goal of acute ischemic stroke (AIS) treatment. Mechanical thrombectomy (MT) may be proposed up to 6 hours and from 6 to 24 hours after stroke onset if multimodal imaging demonstrates the presence of a substantial ischemic penumbra. Despite the major benefit associated with MT, more than half of patients will remain disabled at 3 months. The rate of complete reperfusion after MT appears to be a major factor affecting functional outcome. However, this rate of complete reperfusion is only achieved in 50 % of the patients due to, at least in part, distal microcirculatory impairment and or erratic emboli. In coronary artery disease, new antiplatelet agents, with a very short half-life, such as P2Y12 inhibitors (P2Y12I), have been shown to reduce in-stent thrombosis, myocardial infarction and death. The IV route for P2Y12 inhibitors administration is adapted to the stroke population who has frequently dysphagia that prevents per os drug administration. In addition, the very short half-life of the drug is quite interesting for the management of hemorrhagic complications or emergent surgical interventions and early antithrombotic secondary prevention initiation. Hypothesis: subgroup of patients treated from 0 to 24 hours after onset with a demonstrated ischemic penumbra on perfusion imaging, the administration of P2Y12I in addition to MT and best medical management (BMM) may increase reperfusion rates and improve functional outcome compared to MT with BMM alone.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
368
administration of cangrolor by iv befor thrombectomy
used yhe best medical management
CHU de Besançon
Besançon, France
RECRUITINGHôpital Pellegrin (CHU de Bordeaux)
Bordeaux, France
RECRUITINGHospices civils de Lyon, Hôpital Pierre Wertheimer
Bron, France
RECRUITINGHôpital Salengro (CHU Lille)
Lille, France
RECRUITINGHôpital Dupuytren (CHU Limoges)
Limoges, France
RECRUITINGCHU La Timone
Marseille, France
RECRUITINGHôpital Central (CHU de Nancy)
Nancy, France
RECRUITINGHôpital Lariboisière AP-HP
Paris, France
RECRUITINGHôpital Pitié-Salpêtrière AP-HP
Paris, France
RECRUITINGHôpital Fondation A de Rothschild
Paris, France
RECRUITING...and 3 more locations
Favorable functional evaluation at 3 month for patients with acute ischemic strocke treated by cangrelor.
The favorable functional outcome at 3 month will be evaluated using a modified Rankin Scale (mRS). The scale runs from 0 to 6, running from perfect health without symptoms to death (0: no symptoms, 3: Moderate disability. Requires some help, but able to walk unassisted, 6: Dead).
Time frame: 3 months
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