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Efficacy and safety of mechanical thrombectomy in distal medium middle cerebral artery occlusion ischemic stroke patients on low-dose aspirin

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-str...

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Main Authors: Salim, Hamza (Author) , Yedavalli, Vivek (Author) , Milhem, Fathi (Author) , Musmar, Basel (Author) , Adeeb, Nimer (Author) , Daraghma, Motaz (Author) , El Naamani, Kareem (Author) , Henninger, Nils (Author) , Sundararajan, Sri Hari (Author) , Kühn, Anna Luisa (Author) , Khalife, Jane (Author) , Ghozy, Sherief (Author) , Scarcia, Luca (Author) , Tan, Benjamin YQ (Author) , Regenhardt, Robert W (Author) , Heit, Jeremy J (Author) , Cancelliere, Nicole M (Author) , Bernstock, Joshua D (Author) , Rouchaud, Aymeric (Author) , Fiehler, Jens (Author) , Sheth, Sunil (Author) , Puri, Ajit S (Author) , Dyzmann, Christian (Author) , Colasurdo, Marco (Author) , Renieri, Leonardo (Author) , Filipe, João Pedro (Author) , Harker, Pablo (Author) , Radu, Răzvan Alexandru (Author) , Abdalkader, Mohamad (Author) , Klein, Piers (Author) , Marotta, Thomas R (Author) , Spears, Julian (Author) , Ota, Takahiro (Author) , Mowla, Ashkan (Author) , Jabbour, Pascal (Author) , Biswas, Arundhati (Author) , Clarençon, Frédéric (Author) , Siegler, James E (Author) , Nguyen, Thanh N (Author) , Varela, Ricardo (Author) , Baker, Amanda (Author) , Essibayi, Muhammed Amir (Author) , Altschul, David (Author) , Gonzalez, Nestor R (Author) , Möhlenbruch, Markus Alfred (Author) , Costalat, Vincent (Author) , Gory, Benjamin (Author) , Stracke, Christian Paul (Author) , Hecker, Constantin (Author) , Shaikh, Hamza (Author) , Griessenauer, Christoph J (Author) , Liebeskind, David S (Author) , Pedicelli, Alessandro (Author) , Alexandre, Andrea M (Author) , Tancredi, Illario (Author) , Faizy, Tobias D (Author) , Kalsoum, Erwah (Author) , Wintermark, Max (Author) , Lubicz, Boris (Author) , Patel, Aman B (Author) , Pereira, Vitor Mendes (Author) , Guenego, Adrien (Author) , Dmytriw, Adam A. (Author)
Format: Article (Journal)
Language:English
Published: January 28, 2025
In: International journal of stroke
Year: 2025, Volume: 20, Issue: 6, Pages: 669-678
ISSN:1747-4949
DOI:10.1177/17474930251317883
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1177/17474930251317883
Verlag, kostenfrei, Volltext: https://journals.sagepub.com/doi/10.1177/17474930251317883
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Author Notes:Hamza Adel Salim, Vivek Yedavalli, Fathi Milhem, Basel Musmar, Nimer Adeeb, Motaz Daraghma, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Benjamin YQ Tan, Robert W Regenhardt, Jeremy J Heit, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, Muhammed Amir Essibayi, David Altschul, Nestor R Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Hamza Shaikh, Christoph J Griessenauer, David S Liebeskind, Alessandro Pedicelli, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Max Wintermark, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Adrien Guenego and Adam A Dmytriw; for the MAD MT Investigators
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Summary: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 (modified Rankin Scale (mRS), 0-2). Secondary outcomes included excellent functional outcome at 90 days (mRS, 0-1), mortality, and day 1 post-MT National Institutes of Health Stroke Scale (NIHSS) score. Safety outcomes focused on hemorrhagic complications, including symptomatic intracerebral hemorrhage (sICH). - Results: Among 1354 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: odds ratio (OR) = 1.89, 95% confidence interval (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 1 (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.
Item Description:Gesehen am 12.09.2025
Physical Description:Online Resource
ISSN:1747-4949
DOI:10.1177/17474930251317883

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