Abstract Body: Introduction: 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. Aspirin use was associated with significantly better functional outcomes (mRS 0-2: OR = 2.12, 95% CI, 1.29 to 3.49; mRS 0-1: OR = 1.87, 95% CI, 1.12 to 3.14;) and lower 90-day mortality (OR = 0.53, 95% CI, 0.30 to 0.95). The aspirin group had lower NIHSS scores on day one (β = -2.0, 95% CI, -3.3 to -0.70). The rate of sICH was not significantly different between the groups (OR = 0.98, 95% CI, 0.56 to 1.72).
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.