Citations 2
GLP-1 Receptor Agonist Use Is Associated With Lower Risk of Intracranial Aneurysm Rupture and Rupture Severity
Chen, Huanwen , McIntyre, Matthew K. , Kakadiya, Jay , Rai, Pranjal , Essibayi, Muhammed Amir , Salim, Hamza A., Latifikhereshky, Shahrzad, Yedavalli, Vivek S., Altschul, David , Gandhi, Dheeraj, Lakhani, Dhairya A. , Yedavalli, Vivek , Salim, Hamza , Salim, Hamza , Azzam, Ahmed Y , Yedavalli, Vivek S , Altschul, David J , Dmytriw, Adam A , Colasurdo, Marco , Malhotra, Ajay , Gandhi, Dheeraj , Lakhani, Dhairya , Kakadiya, Jay , Rai, Pranjal , Essibayi, Muhammed Amir , Dmytriw, Adam A. , Colasurdo, Marco , Malhotra, Ajay
Stroke | May 21, 2026 | Volume: 57 | Issue: 7 | Pages: 1979-1990
BACKGROUND: Unruptured intracranial aneurysms (UIAs) affect up to 5% of the population, and rupture can lead to devastating subarachnoid hemorrhage. GLP-1RAs (glucagon-like peptide-1 receptor agonists) have anti-inflammatory and vasculoprotective effects, but their impact on aneurysm stability and subarachnoid hemorrhage outcomes is unexplored. This study evaluated whether GLP-1RA use is associated with reduced rupture risk and attenuated severity in the event of a rupture. METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network (2016–2024). Cohort 1 included patients with newly diagnosed, untreated UIA; cohort 2 included those who suffered aneurysm rupture. GLP-1RA exposure was defined as use before or within 3 months of UIA diagnosis (cohort 1) or before rupture (cohort 2). The primary outcome was aneurysm rupture risk in cohort 1. Secondary outcomes include presentation severity, vasospasm, and mortality in cohort 2. Propensity score matching balanced demographics, comorbidities, and medications. RESULTS: After propensity score match, cohort 1 of patients with untreated UIA included 8088 GLP-1RA users and 8088 nonusers. GLP-1RA use was associated with significantly lower probabilities of aneurysm rupture at 1-year (0.65% versus 1.51%; P <0.001), 3-year (1.18% versus 1.85%; P <0.001), and 5-year (1.49% versus 2.10%; P <0.001) timepoints, representing a 48% decrease in hazards (hazard ratio, 0.52 [95% CI, 0.38–0.69]). Among patients who suffered aneurysm rupture (cohort 2, N=298 after propensity score match), prerupture GLP-1RA use (n=149) was associated with lower rates of intraparenchymal hemorrhage (17.4% versus 33.6%; P <0.001), intraventricular hemorrhage (10.1% versus 23.5%; P <0.001), and clinically significant vasospasm (10.7% versus 24.2%; P =0.002), as well as numerically lower rates of 30-day mortality (9.4% versus 14.1%; P =0.21). CONCLUSIONS: For patients with untreated UIA, GLP-1RA use was associated with a 48% reduction in aneurysm rupture risk and, among those who suffered aneurysm rupture, milder clinical and radiographic severity. These findings suggest possible neuroprotective and vascular stabilizing effects of GLP-1RAs for patients with UIA.
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.