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Background Intracranial aneurysms can lead to rupture, subarachnoid hemorrhage, or mortality. Endovascular procedures, such as stent-assisted coiling and flow diversion, necessitate the use of antiplatelet drugs to reduce the risk of thromboembolic incidents. Oral P2Y12 inhibitors face challenges due to their slow onset of action and inconsistent responses. Cangrelor, an intravenous P2Y12 inhibitor with rapid action, may provide a safer and more effective option for acute neuro-interventional treatments. The aims were to examine the effectiveness of cangrelor in the endovascular management of intracranial aneurysms and to evaluate its safety and tolerability in this specific clinical setting.Methods A systematic review and a proportionality meta-analysis were performed in accordance with PRISMA guidelines. Searches were conducted in PubMed, Embase, and the Cochrane Library through February 2026 for research on cangrelor as an intervention for intracranial aneurysms. Studies eligible for inclusion consisted of randomized controlled trials and both prospective and retrospective observational studies. Reviews, editorials, case reports, and non-English publications were excluded. Pooled proportions were determined using a random-effects model with the Freeman-Tukey double arcsine transformation. Heterogeneity was evaluated using the I 2 test, and bias risk was assessed through the Newcastle-Ottawa Scale.Results Out of 2,459 articles reviewed, 11 studies involving 278 patients were selected for inclusion. Positive clinical outcomes (mRS 0-2) were observed in 83 out of 143 (58.04%) patients (p<0.001; I 2=76.4%). Symptomatic intracranial hemorrhage occurred in 13 out of 278 (4.67%) patients (p<0.001; I2=0%), while thrombotic events were reported in 9 out of 155 (5.8%) patients (p<0.001; I2=0%). The mortality rate was low, with 8 out of 148 patients (5.4%) (p<0.001; I2=18.8%). The majority of studies indicated a low risk of bias.Conclusion Cangrelor shows a promising safety and efficacy profile in the endovascular treatment of intracranial aneurysms, especially for patients requiring rapid antiplatelet coverage. Larger-scale prospective studies are needed to verify these results and clarify their clinical significance.Disclosures T. Patel: None.