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

被引：0

作者：

Salim, Hamza Adel ^{[1
,2
,3
]}

Yedavalli, Vivek ^{[1
]}

Milhem, Fathi ^{[2
,3
]}

Musmar, Basel ^{[4
]}

Adeeb, Nimer ^{[5
]}

Daraghma, Motaz ^{[2
,3
]}

El Naamani, Kareem ^{[4
]}

Henninger, Nils ^{[6
]}

Sundararajan, Sri Hari ^{[7
]}

Kuhn, Anna Luisa ^{[8
]}

Khalife, Jane ^{[9
]}

Ghozy, Sherief ^{[10
,11
]}

Scarcia, Luca ^{[12
]}

Tan, Benjamin Y. Q.

Regenhardt, Robert W. ^{[2
,3
]}

Heit, Jeremy J. ^{[13
]}

Cancelliere, Nicole M. ^{[14
,15
]}

Bernstock, Joshua D. ^{[16
]}

Rouchaud, Aymeric ^{[17
]}

Fiehler, Jens ^{[18
]}

Sheth, Sunil ^{[19
]}

Puri, Ajit S. ^{[8
]}

Dyzmann, Christian ^{[20
]}

Colasurdo, Marco ^{[21
]}

Renieri, Leonardo ^{[22
]}

Filipe, Joao Pedro ^{[23
]}

Harker, Pablo ^{[24
]}

Radu, Razvan Alexandru ^{[25
]}

Abdalkader, Mohamad ^{[26
,27
]}

Klein, Piers ^{[26
,27
]}

Marotta, Thomas R.

Spears, Julian

Ota, Takahiro ^{[28
]}

Mowla, Ashkan ^{[29
]}

Jabbour, Pascal ^{[4
]}

Biswas, Arundhati ^{[30
]}

Clarencon, Frederic ^{[31
,32
]}

Siegler, James E. ^{[9
]}

Nguyen, Thanh N. ^{[26
,27
]}

Varela, Ricardo ^{[33
]}

Baker, Amanda ^{[34
,35
]}

Essibayi, Muhammed Amir ^{[34
,35
]}

Altschul, David ^{[34
,35
]}

Gonzalez, Nestor R. ^{[36
]}

Moehlenbruch, Markus A. ^{[37
,38
]}

Costalat, Vincent

Gory, Benjamin ^{[38
,39
]}

Stracke, Christian Paul ^{[40
,41
]}

Hecker, Constantin ^{[42
]}

Shaikh, Hamza ^{[9
]}

机构：

[1] Johns Hopkins Med Ctr, Dept Radiol, Div Neuroradiol, Baltimore, MD USA

[2] Harvard Med Sch, Harvard Univ, Massachusetts Gen Hosp, Neuroendovascular Program, Boston, MA 02115 USA

[3] Harvard Med Sch, Harvard Univ, Brigham & Womens Hosp, Boston, MA 02115 USA

[4] Thomas Jefferson Univ, Dept Neurosurg, Philadelphia, PA 19107 USA

[5] Louisiana State Univ, Dept Neurosurg & Intervent Neuroradiol, Baton Rouge, LA USA

[6] Univ Massachusetts, Dept Neurol, Chan Med Sch, Worcester, MA USA

[7] NJMS, Dept Endovascular Neurosurg & Neuroradiol, Newark, NJ USA

[8] Univ Massachusetts, Med Ctr, Dept Radiol, Div Neurointervent Radiol, Worcester, MA USA

[9] Rowan Univ, Cooper Univ Hosp, Cooper Neurol Inst, Cooper Med Sch, Camden, NJ 08103 USA

[10] Mayo Clin, Dept Neurol Surg, Rochester, MN USA

[11] Mayo Clin, Dept Radiol, Rochester, MN USA

[12] Henri Mondor Hosp, Dept Neuroradiol, Creteil, France

[13] Stanford Med Ctr, Dept Intervent Neuroradiol, Palo Alto, CA USA

[14] Univ Toronto, St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada

[15] Univ Toronto, St Michaels Hosp, Neurovasc Ctr, Div Neurosurg, Toronto, ON, Canada

[16] Harvard Med Sch, Brigham & Womens Hosp, Dept Neurosurg, Boston, MA USA

[17] Dupuytren Univ Limoges, Univ Hosp Limoges, Neuroradiol Dept, XLIM CNRS,UMR 7252, F-7252 Limoges, France

[18] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany

[19] UTHealth, Dept Neurol, McGovern Med Sch, Houston, TX USA

[20] Lubeck GmbH, Neuroradiol Dept, Sana Kliniken, Lubeck, Germany

[21] Oregon Hlth & Sci Univ, Dept Intervent Radiol, Portland, OR USA

[22] Osped Careggi Firenze, Interventist Neurovascolare, Florence, Italy

[23] Ctr Hospitalar Univ Porto, Dept Diagnost & Intervent Neuroradiol, Porto, Portugal

[24] Univ Cincinnati, Dept Neurol, Med Ctr, Cincinnati, OH USA

[25] Montpellier Univ, Gui Chauliac Hosp, Dept Neuroradiol, Med Ctr, Montpellier, France

[26] Boston Med Ctr, Dept Radiol, Boston, MA USA

[27] Boston Med Ctr, Dept Neurol, Boston, MA USA

[28] Tokyo Metropolitan Tama Med Ctr, Dept Neurosurg, Tokyo, Japan

[29] Univ Southern Calif USC, Keck Sch Med, Dept Neurol Surg, Div Stroke & Endovascular Neurosurg, Los Angeles, CA USA

[30] New York Med Coll, Westchester Med Ctr, Dept Neurosurg, Valhalla, NY USA

[31] Hop La Pitie Salpetriere, Dept Neuroradiol, Paris, France

[32] Sorbonne Univ Paris VI, GRC BioFast, Paris, France

[33] Univ Porto, Dept Neurol, Ctr Hosp, Porto, Portugal

[34] Albert Einstein Coll Med, Montefiore Med Ctr, Dept Neurol Surg, Bronx, NY USA

[35] Albert Einstein Coll Med, Montefiore Med Ctr, Montefiore Einstein Cerebrovascular Res Lab, Bronx, NY USA

[36] Cedars Sinai Med Ctr, Dept Neurosurg, Los Angeles, CA USA

[37] Sekt Vaskulare & Interventionelle Neuroradiol, Universitatsklinikum Heidelberg, Heidelberg, Germany

[38] Nancy Univ Hosp, Dept Intervent Neuroradiol, Nancy, France

[39] Univ Lorraine, INSERM U1254, IADI, Nancy, France

[40] Univ Med Ctr Munster, Dept Radiol, Intervent Neuroradiol Sect, Munster, Germany

[41] Paracelsus Med Univ Salzburg, Dept Neurol, Christian Doppler Clin, Salzburg, Austria

[42] Paracelsus Med Univ Salzburg, Dept Neurosurg, Christian Doppler Clin, Salzburg, Austria

[43] UCLA, UCLA Stroke Ctr, Los Angeles, CA USA

[44] UCLA, Dept Neurol Dept, Los Angeles, CA USA

[45] Fdn Policlin Univ A Gemelli IRCCS, UOSA Neuroradiol Interventist, Rome, Italy

[46] Hop Civil Marie Curie, Dept Neurol, Charleroi, Belgium

[47] Univ Med Ctr Munster, Dept Radiol Neuroendovascular Program, Munster, Germany

[48] MD Anderson Med Ctr, Dept Neuroradiol, Houston, TX USA

[49] Erasme Univ Hosp, Dept Diagnost & Intervent Neuroradiol, Brussels, Belgium

来源：

INTERNATIONAL JOURNAL OF STROKE | 2025年

关键词：

Acute ischemic stroke; distal medium vessel occlusions; mechanical thrombectomy; aspirin; PROPENSITY SCORE ESTIMATION; ENDOVASCULAR THROMBECTOMY; ANTIPLATELET TREATMENT; THERAPY;

D O I：

10.1177/17474930251317883

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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 (beta = -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.

引用

页数：10

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