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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
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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.

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10.1177/17474930251317883
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39873268
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