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

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; Adam A. Dmytriw

doi:10.1177/17474930251317883

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

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, Adam A. Dmytriw

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

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.

Original language	English (US)
Pages (from-to)	669-678
Number of pages	10
Journal	International Journal of Stroke
Volume	20
Issue number	6
DOIs	https://doi.org/10.1177/17474930251317883
State	Published - Jul 2025
Externally published	Yes

Keywords

Acute ischemic stroke
aspirin
distal medium vessel occlusions
mechanical thrombectomy

ASJC Scopus subject areas

Neurology
Clinical Neurology

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10.1177/17474930251317883

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Salim, H. A., Yedavalli, V., Milhem, F., Musmar, B., Adeeb, N., Daraghma, M., El Naamani, K., Henninger, N., Sundararajan, S. H., Kühn, A. L., Khalife, J., Ghozy, S., Scarcia, L., Tan, B. YQ., Regenhardt, R. W., Heit, J. J., Cancelliere, N. M., Bernstock, J. D., Rouchaud, A., ... Dmytriw, A. A. (2025). Efficacy and safety of mechanical thrombectomy in distal medium middle cerebral artery occlusion ischemic stroke patients on low-dose aspirin. International Journal of Stroke, 20(6), 669-678. https://doi.org/10.1177/17474930251317883

Salim, HA, Yedavalli, V, Milhem, F, Musmar, B, Adeeb, N, Daraghma, M, El Naamani, K, Henninger, N, Sundararajan, SH, Kühn, AL, Khalife, J, Ghozy, S, Scarcia, L, Tan, BYQ, Regenhardt, RW, Heit, JJ, Cancelliere, NM, Bernstock, JD, Rouchaud, A, Fiehler, J, Sheth, S, Puri, AS, Dyzmann, C, Colasurdo, M, Renieri, L, Filipe, JP, Harker, P, Radu, RA, Abdalkader, M, Klein, P, Marotta, TR, Spears, J, Ota, T, Mowla, A, Jabbour, P, Biswas, A, Clarençon, F, Siegler, JE, Nguyen, TN, Varela, R, Baker, A, Essibayi, MA, Altschul, D, Gonzalez, NR, Möhlenbruch, MA, Costalat, V, Gory, B, Stracke, CP, Hecker, C, Shaikh, H, Griessenauer, CJ, Liebeskind, DS, Pedicelli, A, Alexandre, AM, Tancredi, I, Faizy, TD, Kalsoum, E, Wintermark, M, Lubicz, B, Patel, AB, Pereira, VM, Guenego, A & Dmytriw, AA 2025, 'Efficacy and safety of mechanical thrombectomy in distal medium middle cerebral artery occlusion ischemic stroke patients on low-dose aspirin', International Journal of Stroke, vol. 20, no. 6, pp. 669-678. https://doi.org/10.1177/17474930251317883

@article{fd0118beec1e48b9a400afe281635ebc,

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

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",

author = "Salim, \{Hamza Adel\} and Vivek Yedavalli and Fathi Milhem and Basel Musmar and Nimer Adeeb and Motaz Daraghma and \{El Naamani\}, Kareem and Nils Henninger and Sundararajan, \{Sri Hari\} and K{\"u}hn, \{Anna Luisa\} and Jane Khalife and Sherief Ghozy and Luca Scarcia and Tan, \{Benjamin YQ\} and Regenhardt, \{Robert W.\} and Heit, \{Jeremy J.\} and Cancelliere, \{Nicole M.\} and Bernstock, \{Joshua D.\} and Aymeric Rouchaud and Jens Fiehler and Sunil Sheth and Puri, \{Ajit S.\} and Christian Dyzmann and Marco Colasurdo and Leonardo Renieri and Filipe, \{Jo{\~a}o Pedro\} and Pablo Harker and Radu, \{R{\u a}zvan Alexandru\} and Mohamad Abdalkader and Piers Klein and Marotta, \{Thomas R.\} and Julian Spears and Takahiro Ota and Ashkan Mowla and Pascal Jabbour and Arundhati Biswas and Fr{\'e}d{\'e}ric Claren{\c c}on and Siegler, \{James E.\} and Nguyen, \{Thanh N.\} and Ricardo Varela and Amanda Baker and Essibayi, \{Muhammed Amir\} and David Altschul and Gonzalez, \{Nestor R.\} and M{\"o}hlenbruch, \{Markus A.\} and Vincent Costalat and Benjamin Gory and Stracke, \{Christian Paul\} and Constantin Hecker and Hamza Shaikh and Griessenauer, \{Christoph J.\} and Liebeskind, \{David S.\} and Alessandro Pedicelli and Alexandre, \{Andrea M.\} and Illario Tancredi and Faizy, \{Tobias D.\} and Erwah Kalsoum and Max Wintermark and Boris Lubicz and Patel, \{Aman B.\} and Pereira, \{Vitor Mendes\} and Adrien Guenego and Dmytriw, \{Adam A.\}",

note = "Publisher Copyright: {\textcopyright} 2025 World Stroke Organization. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).",

year = "2025",

month = jul,

doi = "10.1177/17474930251317883",

language = "English (US)",

volume = "20",

pages = "669--678",

journal = "International Journal of Stroke",

issn = "1747-4930",

publisher = "SAGE Publications Ltd",

number = "6",

}

TY - JOUR

T1 - Efficacy and safety of mechanical thrombectomy in distal medium middle cerebral artery occlusion ischemic stroke patients on low-dose aspirin

AU - Salim, Hamza Adel

AU - Yedavalli, Vivek

AU - Milhem, Fathi

AU - Musmar, Basel

AU - Adeeb, Nimer

AU - Daraghma, Motaz

AU - El Naamani, Kareem

AU - Henninger, Nils

AU - Sundararajan, Sri Hari

AU - Kühn, Anna Luisa

AU - Khalife, Jane

AU - Ghozy, Sherief

AU - Scarcia, Luca

AU - Tan, Benjamin YQ

AU - Regenhardt, Robert W.

AU - Heit, Jeremy J.

AU - Cancelliere, Nicole M.

AU - Bernstock, Joshua D.

AU - Rouchaud, Aymeric

AU - Fiehler, Jens

AU - Sheth, Sunil

AU - Puri, Ajit S.

AU - Dyzmann, Christian

AU - Colasurdo, Marco

AU - Renieri, Leonardo

AU - Filipe, João Pedro

AU - Harker, Pablo

AU - Radu, Răzvan Alexandru

AU - Abdalkader, Mohamad

AU - Klein, Piers

AU - Marotta, Thomas R.

AU - Spears, Julian

AU - Ota, Takahiro

AU - Mowla, Ashkan

AU - Jabbour, Pascal

AU - Biswas, Arundhati

AU - Clarençon, Frédéric

AU - Siegler, James E.

AU - Nguyen, Thanh N.

AU - Varela, Ricardo

AU - Baker, Amanda

AU - Essibayi, Muhammed Amir

AU - Altschul, David

AU - Gonzalez, Nestor R.

AU - Möhlenbruch, Markus A.

AU - Costalat, Vincent

AU - Gory, Benjamin

AU - Stracke, Christian Paul

AU - Hecker, Constantin

AU - Shaikh, Hamza

AU - Griessenauer, Christoph J.

AU - Liebeskind, David S.

AU - Pedicelli, Alessandro

AU - Alexandre, Andrea M.

AU - Tancredi, Illario

AU - Faizy, Tobias D.

AU - Kalsoum, Erwah

AU - Wintermark, Max

AU - Lubicz, Boris

AU - Patel, Aman B.

AU - Pereira, Vitor Mendes

AU - Guenego, Adrien

AU - Dmytriw, Adam A.

N1 - Publisher Copyright: © 2025 World Stroke Organization. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

PY - 2025/7

Y1 - 2025/7

N2 - 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.

AB - 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.

KW - Acute ischemic stroke

KW - aspirin

KW - distal medium vessel occlusions

KW - mechanical thrombectomy

UR - https://www.scopus.com/pages/publications/105000281062

UR - https://www.scopus.com/pages/publications/105000281062#tab=citedBy

U2 - 10.1177/17474930251317883

DO - 10.1177/17474930251317883

M3 - Article

C2 - 39873268

AN - SCOPUS:105000281062

SN - 1747-4930

VL - 20

SP - 669

EP - 678

JO - International Journal of Stroke

JF - International Journal of Stroke

IS - 6

ER -

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

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