Efficacy and Safety of Mechanical Thrombectomy in Distal Medium Middle Cerebral Artery Occlusion Ischemic Stroke Patients on Low-Dose Aspirin
Salim, Hamza A ; Yedavalli, Vivek ; Milhem, Fathi ; Musmar, Basel ; Adeeb, Nimer ; Daraghma, Motaz ; El Naamani, Kareem ; Henninger, Nils ; Sundararajan, Sri Hari ; Kuhn, Anna ... show 10 more
Authors
Yedavalli, Vivek
Milhem, Fathi
Musmar, Basel
Adeeb, Nimer
Daraghma, Motaz
El Naamani, Kareem
Henninger, Nils
Sundararajan, Sri Hari
Kuhn, Anna
Khalife, Jane
Ghozy, Sherief
Scarcia, Luca
Tan, Benjamin Yq
Regenhardt, Robert
Heit, Jeremy
Cancelliere, Nicole Mariantonia
Bernstock, Joshua
Rouchaud, Aymeric
Fiehler, Jens
Sheth, Sunil A
Puri, Ajit S
Dyzmann, Christian
Colasurdo, Marco
Renieri, Leonardo
Filipe, João Pedro
Harker, Pablo
Radu, Răzvan Alexandru
Abdalkader, Mohamad
Klein, Piers
Marrota, Thomas
Spears, Julian
Ota, Takahiro
Mowla, Ashkan
Jabbour, Pascal
Biswas, Arundhati
Clarencon, Frederic
Siegler, James E
Nguyen, Thanh N
Varela, Ricardo
Baker, Amanda
Essibayi, Muhammed Amir
Altschul, David
Gonzalez, Nestor
Möhlenbruch, Markus
Costalat, Vincent
Gory, Benjamin
Stracke, Christian
Hecker, Constantin
Shaikh, Hamza
Griessenaur, Christoph
Liebeskind, David S
Pedicelli, Alessandro
Alexandre, Andrea
Tancredi, Illario
Faizy, Tobias Djamsched
Kalsoum, Erwah
Wintermark, Max
Lubicz, Boris
Patel, Aman B
Pereira, Vitor Mendes
Guenego, Adrien
Dmytriw, Adam
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Abstract
Background: Acute ischemic stroke (AIS) from distal medium vessel occlusion (DMVO) presents unique treatment challenges. Mechanical thrombectomy (MT) is emerging as a viable option for these patients, yet the role of pre-stroke aspirin treatment is unclear. This study evaluates the impact of pre-stroke low-dose aspirin on outcomes in DMVO patients undergoing MT.
Methods: We conducted a multinational, multicenter, propensity score-weighted analysis within the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. Patients with AIS due to DMVO, treated with MT, were included. We compared outcomes between patients on pre-stroke low-dose aspirin (75-100 mg) and those not on antiplatelet therapy. The primary outcome was functional independence at 90 days (mRS 0-2). Secondary outcomes included excellent functional outcome at 90 days (mRS 0-1), mortality, and day-one post-MT NIHSS score. Safety outcomes focused on hemorrhagic complications, including symptomatic intracerebral hemorrhage (sICH).
Results: Among 1,354 patients, 150 were on pre-stroke low-dose aspirin. After applying Inverse Probability of Treatment Weighting (IPTW), Aspirin use was associated with significantly better functional outcomes (mRS 0-2: OR =1.89 , 95% CI, 1.14 to 3.12 ) and lower 90-day mortality (OR = 0.56, 95% CI, 0.32 to 1.00). The aspirin group had lower NIHSS scores on day one (β = -1.5, 95% CI, -2.8 to - 0.27). The sICH rate was not significantly different between the groups (OR = 0.92, 95% CI, 0.60 to 1.43).
Conclusions: Pre-stroke low-dose aspirin was associated with improved functional outcomes and reduced mortality in patients with DMVO undergoing MT, without a significant increase in sICH. These findings suggest that low-dose aspirin may be safe and associated with more frequent excellent outcomes for this patient population. Further prospective studies are needed to validate these results and assess long-term outcomes.
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Salim HA, Yedavalli V, Milhem F, Musmar B, Adeeb N, Daraghma M, El Naamani K, Henninger N, Sundararajan SH, Kuhn A, Khalife J, Ghozy S, Scarcia L, Tan BY, Regenhardt R, Heit J, Cancelliere NM, Bernstock J, Rouchaud A, Fiehler J, Sheth SA, Puri AS, Dyzmann C, Colasurdo M, Renieri L, Filipe JP, Harker P, Radu RA, Abdalkader M, Klein P, Marrota T, Spears J, Ota T, Mowla A, Jabbour P, Biswas A, Clarencon F, Siegler JE, Nguyen TN, Varela R, Baker A, Essibayi MA, Altschul D, Gonzalez N, Möhlenbruch M, Costalat V, Gory B, Stracke C, Hecker C, Shaikh H, Griessenaur C, Liebeskind DS, Pedicelli A, Alexandre A, Tancredi I, Faizy TD, Kalsoum E, Wintermark M, Lubicz B, Patel AB, Pereira VM, Guenego A, Dmytriw A. Efficacy and Safety of Mechanical Thrombectomy in Distal Medium Middle Cerebral Artery Occlusion Ischemic Stroke Patients on Low-Dose Aspirin. Int J Stroke. 2025 Jan 28:17474930251317883. doi: 10.1177/17474930251317883. Epub ahead of print. PMID: 39873268.