Multicenter Study

. 2025 Jul;20(6):669-678.

doi: 10.1177/17474930251317883. Epub 2025 Jan 28.

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

Hamza Adel Salim^{1

2}, Vivek Yedavalli¹, Fathi Milhem², Basel Musmar³, Nimer Adeeb⁴, Motaz Daraghma², Kareem El Naamani³, Nils Henninger⁵, Sri Hari Sundararajan⁶, Anna Luisa Kühn⁷, Jane Khalife⁸, Sherief Ghozy⁹, Luca Scarcia¹⁰, Benjamin Yq Tan^{11

12}, Robert W Regenhardt², Jeremy J Heit¹³, Nicole M Cancelliere¹⁴, Joshua D Bernstock¹⁵, Aymeric Rouchaud¹⁶, Jens Fiehler¹⁷, Sunil Sheth¹⁸, Ajit S Puri⁷, Christian Dyzmann¹⁹, Marco Colasurdo²⁰, Leonardo Renieri²¹, João Pedro Filipe²², Pablo Harker²³, Răzvan Alexandru Radu²⁴, Mohamad Abdalkader²⁵, Piers Klein²⁵, Thomas R Marotta¹⁴, Julian Spears¹⁴, Takahiro Ota²⁶, Ashkan Mowla²⁷, Pascal Jabbour³, Arundhati Biswas²⁸, Frédéric Clarençon^{29

30}, James E Siegler⁸, Thanh N Nguyen²⁵, Ricardo Varela³¹, Amanda Baker³², Muhammed Amir Essibayi³², David Altschul³², Nestor R Gonzalez³³, Markus A Möhlenbruch³⁴, Vincent Costalat²⁴, Benjamin Gory^{35

36}, Christian Paul Stracke³⁷, Constantin Hecker³⁸, Hamza Shaikh⁸, Christoph J Griessenauer³⁸, David S Liebeskind³⁹, Alessandro Pedicelli⁴⁰, Andrea M Alexandre⁴⁰, Illario Tancredi⁴¹, Tobias D Faizy⁴², Erwah Kalsoum¹⁰, Max Wintermark⁴³, Boris Lubicz⁴⁴, Aman B Patel², Vitor Mendes Pereira¹⁴, Adrien Guenego⁴⁴, Adam A Dmytriw^{2

14}

Affiliations

¹ Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
² Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA.
³ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
⁴ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA.
⁵ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁶ Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.
⁷ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
⁸ Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA.
⁹ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
¹⁰ Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
¹¹ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹² Division of Neurology, Department of Medicine, National University Hospital, Singapore.
¹³ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
¹⁴ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
¹⁵ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁶ University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
¹⁷ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁸ Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
¹⁹ Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
²⁰ Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA.
²¹ Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
²² Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
²³ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
²⁴ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
²⁵ Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
²⁶ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
²⁷ Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.
²⁸ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
²⁹ Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
³⁰ GRC BioFast, Sorbonne University, Paris VI, Paris, France.
³¹ Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
³² Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
³³ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³⁴ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
³⁵ Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
³⁶ INSERM U1254, IADI, Université de Lorraine, Nancy, France.
³⁷ Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany.
³⁸ Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.
³⁹ UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, CA, USA.
⁴⁰ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
⁴¹ Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
⁴² Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany.
⁴³ Department of Neuroradiology, MD Anderson Medical Center, Houston, TX, USA.
⁴⁴ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.

PMID: 39873268
PMCID: PMC12182599
DOI: 10.1177/17474930251317883

Multicenter Study

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

Hamza Adel Salim et al. Int J Stroke. 2025 Jul.

. 2025 Jul;20(6):669-678.

doi: 10.1177/17474930251317883. Epub 2025 Jan 28.

Authors

Affiliations

¹ Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
² Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA.
³ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
⁴ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA.
⁵ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁶ Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.
⁷ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
⁸ Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA.
⁹ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
¹⁰ Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
¹¹ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹² Division of Neurology, Department of Medicine, National University Hospital, Singapore.
¹³ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
¹⁴ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
¹⁵ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁶ University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
¹⁷ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁸ Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
¹⁹ Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
²⁰ Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA.
²¹ Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
²² Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
²³ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
²⁴ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
²⁵ Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
²⁶ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
²⁷ Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.
²⁸ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
²⁹ Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
³⁰ GRC BioFast, Sorbonne University, Paris VI, Paris, France.
³¹ Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
³² Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
³³ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³⁴ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
³⁵ Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
³⁶ INSERM U1254, IADI, Université de Lorraine, Nancy, France.
³⁷ Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany.
³⁸ Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.
³⁹ UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, CA, USA.
⁴⁰ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
⁴¹ Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
⁴² Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Münster, Germany.
⁴³ Department of Neuroradiology, MD Anderson Medical Center, Houston, TX, USA.
⁴⁴ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.

PMID: 39873268
PMCID: PMC12182599
DOI: 10.1177/17474930251317883

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 (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.

Keywords: Acute ischemic stroke; aspirin; distal medium vessel occlusions; mechanical thrombectomy.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Regenhardt serves on a DSMB for a trial sponsored by Rapid Medical, serves as site PI for studies sponsored by Penumbra and Microvention, and receives stroke research grant funding from the National Institutes of Health, Society of Vascular and Interventional Neurology, and Heitman Stroke Foundation. Dr Guenego reports consultancy for Rapid Medical and Phenox, not directly related to the present work. Dr Clarençon reports conflicts of interest with Medtronic, Balt Extrusion (consultant), ClinSearch (core lab), Penumbra, Stryker (payment for reading), and Artedrone (Board); all not directly related to the present work. Dr Henninger received support from NINDS NS131756, NINR NR020231, and NINDS NS113844 during the conduct of the study. All unrelated to the present work. Dr Liebeskind is consultant for Imaging Core Lab to Cerenovus, Genentech, Medtronic, Stryker, and Rapid Medical. Dr Griessenauer reports a proctoring agreement with Medtronic and research funding by Penumbra. Dr Nguyen reports Associate Editor of Stroke; advisory board of Brainomix, Aruna Bio. Dr Puri is a consultant for Medtronic Neurovascular, Stryker Neurovascular, Balt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc, and Arsenal Medical; he received research grants from NIH, Microvention, Cerenovus, Medtronic Neurovascular, and Stryker Neurovascular and holds stocks in InNeuroCo, Agile, Perfuze, Galaxy, and NTI. Dr Jabbour is a consultant for Medtronic, Microvention, and Cerus. Dr Siegler has served as a consultant for AstraZeneca and has received funding from the National Institutes of Health (R61NS135583), Viz.ai, Philips, and Medtronic.

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

Affiliations

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

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