GLP-1 receptor agonists and post-endovascular thrombectomy outcomes in acute ischemic stroke: a multicenter...

Glucagon-like peptide-1 receptor agonists (GLP-1As) have demonstrated cardiovascular and cerebrovascular benefits in high-risk populations, but their impact in patients with acute ischemic stroke (AIS) requiring endovascular thrombectomy (EVT) remains uncertain.

We performed a retrospective cohort analysis using the TriNetX Network, identifying adults (≥18 years) with AIS treated with EVT from January 1, 2016 through December 31, 2025. Patients with GLP-1A exposure within three months prior to EVT constituted the exposure cohort; those without served as comparators. This pre-index window was specified to eliminate immortal time bias, with follow-up beginning on the EVT date for both cohorts. Three-year outcomes included all-cause mortality and inpatient hospitalizations. One-to-one propensity score matching was applied using demographic, comorbidity, medication, and metabolic variables including individual National Institute of Health Stroke Scale scores, Hemoglobin A1c, and body mass index.

Among 286 GLP-1A-exposed and 19,263 unexposed EVT-treated patients, 261 matched pairs were analyzed. GLP-1A use was associated with lower all-cause mortality (11.5% vs 29.9%; HR 0.334, 95% CI 0.219-0.508) and fewer inpatient hospitalizations (39.8% vs 54.8%; HR 0.514, 95% CI 0.398-0.663), both p < 0.001.

Among EVT-treated AIS patients, GLP-1A exposure within three months prior to EVT was associated with improved survival and reduced inpatient hospitalizations.