Efficacy and Safety of Mechanical Thrombectomy in Distal Medium Middle Cerebral Artery Occlusion Ischemic Stroke Patients on Low-Dose Aspirin

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dc.contributor.authorSalim, Hamza A
dc.contributor.authorYedavalli, Vivek
dc.contributor.authorMilhem, Fathi
dc.contributor.authorMusmar, Basel
dc.contributor.authorAdeeb, Nimer
dc.contributor.authorDaraghma, Motaz
dc.contributor.authorEl Naamani, Kareem
dc.contributor.authorHenninger, Nils
dc.contributor.authorSundararajan, Sri Hari
dc.contributor.authorKuhn, Anna
dc.contributor.authorKhalife, Jane
dc.contributor.authorGhozy, Sherief
dc.contributor.authorScarcia, Luca
dc.contributor.authorTan, Benjamin Yq
dc.contributor.authorRegenhardt, Robert
dc.contributor.authorHeit, Jeremy
dc.contributor.authorCancelliere, Nicole Mariantonia
dc.contributor.authorBernstock, Joshua
dc.contributor.authorRouchaud, Aymeric
dc.contributor.authorFiehler, Jens
dc.contributor.authorSheth, Sunil A
dc.contributor.authorPuri, Ajit S
dc.contributor.authorDyzmann, Christian
dc.contributor.authorColasurdo, Marco
dc.contributor.authorRenieri, Leonardo
dc.contributor.authorFilipe, João Pedro
dc.contributor.authorHarker, Pablo
dc.contributor.authorRadu, Răzvan Alexandru
dc.contributor.authorAbdalkader, Mohamad
dc.contributor.authorKlein, Piers
dc.contributor.authorMarrota, Thomas
dc.contributor.authorSpears, Julian
dc.contributor.authorOta, Takahiro
dc.contributor.authorMowla, Ashkan
dc.contributor.authorJabbour, Pascal
dc.contributor.authorBiswas, Arundhati
dc.contributor.authorClarencon, Frederic
dc.contributor.authorSiegler, James E
dc.contributor.authorNguyen, Thanh N
dc.contributor.authorVarela, Ricardo
dc.contributor.authorBaker, Amanda
dc.contributor.authorEssibayi, Muhammed Amir
dc.contributor.authorAltschul, David
dc.contributor.authorGonzalez, Nestor
dc.contributor.authorMöhlenbruch, Markus
dc.contributor.authorCostalat, Vincent
dc.contributor.authorGory, Benjamin
dc.contributor.authorStracke, Christian
dc.contributor.authorHecker, Constantin
dc.contributor.authorShaikh, Hamza
dc.contributor.authorGriessenaur, Christoph
dc.contributor.authorLiebeskind, David S
dc.contributor.authorPedicelli, Alessandro
dc.contributor.authorAlexandre, Andrea
dc.contributor.authorTancredi, Illario
dc.contributor.authorFaizy, Tobias Djamsched
dc.contributor.authorKalsoum, Erwah
dc.contributor.authorWintermark, Max
dc.contributor.authorLubicz, Boris
dc.contributor.authorPatel, Aman B
dc.contributor.authorPereira, Vitor Mendes
dc.contributor.authorGuenego, Adrien
dc.contributor.authorDmytriw, Adam
dc.contributor.departmentNeurology
dc.contributor.departmentRadiology
dc.date.accessioned2025-02-03T16:16:05Z
dc.date.available2025-02-03T16:16:05Z
dc.date.issued2025-01-28
dc.description.abstractBackground: 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.
dc.description.embargotypeNo embargo
dc.identifier.citationSalim 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.
dc.identifier.doi10.1177/17474930251317883
dc.identifier.issn1747-4949
dc.identifier.pmid39873268
dc.identifier.urihttps://hdl.handle.net/20.500.14038/54121
dc.language.isoen
dc.relation.ispartofInternational Journal of Stroke
dc.relation.urlhttps://doi.org/10.1177/17474930251317883
dc.source.beginpage17474930251317883
dc.source.countryUnited States
dc.source.journaltitleInternational journal of stroke : official journal of the International Stroke Society
dc.subjectAcute
dc.subjectAntiplatelet therapy
dc.subjectAspirin
dc.subjectIschaemic stroke
dc.subjectStroke
dc.subjectTherapy
dc.titleEfficacy and Safety of Mechanical Thrombectomy in Distal Medium Middle Cerebral Artery Occlusion Ischemic Stroke Patients on Low-Dose Aspirin
dc.typeJournal Article
dspace.entity.typePublication
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