Efficacy and Safety of Mechanical Thrombectomy in Distal Medium Middle Cerebral Artery Occlusion Ischemic Stroke Patients on Low-Dose Aspirin
Authors: Salim Hamza A. , 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 
Published: January 2025

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.