Citations 2
Association of Glucagon-like Peptide-1 Receptor Agonist Use with Stroke and Mortality Outcomes in Asymptomatic Intracranial Atherosclerotic Disease: Propensity Score-Matched Real-World Analysis
Rai, Pranjal , Mandel, Daniel, Dhaduk, Vidhi, Rajeev, Radhika , Kakadiya, Jay , Chen, Huanwen Alvin, Salim, Hamza A., Azzam, Ahmed Y., Essibayi, Muhammed Amir, Connolly, Brian, Buzzelli, Marc, Yedavalli, Vivek S., Khan, M S, Dmytriw, Adam A. , Altschul, David J., McIntyre, Matthew K. , Colasurdo, Marco, Malhotra, Ajay , Gandhi, Dheeraj, Lakhani, Dhairya A. , Yedavalli, Vivek , Khan, Majid , Kakadiya, Jay , Dhaduk, Vidhi , Rajeev, Radhika , Azzam, Ahmed Y , Buzzelli, Marc , Yedavalli, Vivek S , Dmytriw, Adam A , McIntyre, Matthew K , Malhotra, Ajay , Rai, Pranjal , Lakhani, Dhairya , Khan, Majid , Mandel, Daniel, Bathla, Girish , Essibayi, Muhammed Amir , Altschul, David , Colasurdo, Marco , Gandhi, Dheeraj
Neurology International | May 27, 2026 | Volume: 18 | Issue: 5 | Pages: 98
Background: Asymptomatic intracranial atherosclerotic arterial stenosis (ICAS) is an underrecognized entity for which vascular risk-factor optimization is the primary management strategy, with no current indication for routine antiplatelet therapy or endovascular intervention for primary stroke prevention. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce major adverse cardiovascular events, including stroke, in high-risk cardiometabolic populations, but their association with outcomes in asymptomatic ICAS is yet to be evaluated. The present study aims to evaluate the association between GLP-1RA use and cerebrovascular outcomes in adults with asymptomatic ICAS. Materials and Methods: We used the TriNetX US Collaborative Network (71 healthcare organizations) to identify adults (≥18 years) with ICAS between 1 January 2016 and 31 December 2025, and excluded patients with prior cerebral infarction, intracranial hemorrhage, or cerebrovascular ischemic syndromes. Exposure was defined as initiation of any GLP-1 receptor agonist (lixisenatide, semaglutide, liraglutide, tirzepatide, dulaglutide) during the 6 months before or on the date of index ICAS diagnosis. Outcomes were assessed at 1 year, and included ischemic stroke, all-cause mortality, and a composite of ischemic stroke or mortality. Propensity-score matching (1:1) was performed, including demographics, vascular risk factors, comorbidities, antithrombotics, lipid/diabetes therapies, and cardiometabolic laboratory/physiologic measures. Results: Before matching, 1746 GLP-1RA users and 71,792 non-users met inclusion criteria; after matching, 1728 patients remained in each cohort. GLP-1RA use was associated with lower 1-year risk of ischemic stroke (4.40% vs. 6.10%; hazard ratio [HR] 0.70, 95% CI 0.52–0.95; p = 0.044), lower all-cause mortality (3.40% vs. 9.40%; HR 0.35, 95% CI 0.26–0.47; p < 0.001), and lower composite outcome risk (7.50% vs. 15.00%; HR 0.48, 95% CI 0.39–0.59; p < 0.001). Notably, these associations were observed despite matching for HbA1c, LDL cholesterol, BMI, and systolic blood pressure, suggesting potential effects beyond measured cardiometabolic risk profiles. Conclusions: In this large, propensity-matched cohort of adults with a-ICAS, GLP-1RA use was associated with lower ischemic stroke, all-cause mortality, and composite outcome at 1 year. These findings are hypothesis-generating and require further prospective studies to confirm this observation.
Safety and efficacy of ticagrelor versus clopidogrel for carotid artery stenting: propensity score matched analysis
Kakadiya, Jay , Chen, Huanwen , Patankar, Arsh, Salim, Hamza , Essibayi, M, Rai, Pranjal , Azzam, Ahmed Y., Adcock, Amelia , Yedavalli, Vivek S, Dmytriw, Adam A. , Colasurdo, M, Malhotra, Ajay , Gandhi, Dheeraj, Lakhani, Dhairya A. , Essibayi, Muhammed Amir , Yedavalli, Vivek , Kakadiya, Jay , Salim, Hamza , Essibayi, Muhammed Amir , Azzam, Ahmed Y , Yedavalli, Vivek S , Colasurdo, Marco , Rai, Pranjal , Dmytriw, Adam A , Lakhani, Dhairya , Colasurdo, Marco , Malhotra, Ajay , Gandhi, Dheeraj
Journal of NeuroInterventional Surgery | January 13, 2026 | Volume: No volume available | Issue: No issue available | Pages: jnis-2025-024658
Background Dual antiplatelet therapy (DAPT) is recommended around carotid artery stenting (CAS) to reduce periprocedural stroke risk. Clopidogrel is widely used, but response variability related to pharmacokinetics and CYP2C19 polymorphisms may limit its effectiveness. Ticagrelor is a more potent, direct acting P2Y12 inhibitor, but its comparative effectiveness in CAS remains uncertain. Methods We conducted a retrospective cohort study in the TriNetX database, identifying adults with carotid artery stenosis who underwent CAS between January 2016 and August 2025 and received either ticagrelor or clopidogrel. Primary outcomes at 180 days included ischemic stroke, major hemorrhage, intracranial hemorrhage, and all cause mortality. Secondary outcomes included inpatient readmission and emergency department (ED) visits. Propensity score matching (1:1), Kaplan–Meier survival, and Cox proportional hazards analysis were used. Results Among 6996 patients, 378 received ticagrelor and 6618 received clopidogrel; aspirin co-use was similar (89.7% vs 91.7%). After matching, 377 patients remained in each cohort. Ischemic stroke (2.7% vs 4.2%; HR 0.56, 95% CI 0.25 to 1.27; P=0.159) and major hemorrhage (2.9% vs 4.8%; HR 0.61, 95% CI 0.29 to 1.30; P=0.197) were numerically lower with ticagrelor. Rates of intracranial hemorrhage were similar (2.7% vs 2.7%; HR 0.61, 95% CI 0.14 to 2.53; P=0.488). Mortality was numerically higher with ticagrelor (3.4% vs 2.7%; HR 1.64, 95% CI 0.68 to 3.97; P=0.263). ED visits were similar (14.3% vs 14.6%; HR 0.97, 95% CI 0.67 to 1.42; P=0.895). Inpatient readmission was numerically lower with ticagrelor (15.9% vs 19.1%; HR 0.81, 95% CI 0.57 to 1.14; P=0.223). Conclusion Ticagrelor and clopidogrel showed comparable safety and effectiveness following CAS. Future prospective genotype informed trials are warranted to confirm these findings.