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GLP-1 receptor agonist use and aspiration pneumonia risk following endovascular thrombectomy
Journal article   Peer reviewed

GLP-1 receptor agonist use and aspiration pneumonia risk following endovascular thrombectomy

Sahil Sardana, Nihas Mateti, Christopher Todd Hackett, Romil Singh, Suhani Bagga, Dharani Kotekal, Ajna Prahalad, Hassan Abdullah Shakeel, Nancy Kamboj, Muhammad Saim, …
Journal of neurointerventional surgery, Forthcoming
05 Jun 2026
DOI: https://doi.org/10.1136/jnis-2026-025486
PMID: 42248677

Abstract

Drug Complication Thrombectomy Hemorrhage Stroke
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying and may increase aspiration risk, but their impact in patients with acute ischemic stroke patients who are undergoing endovascular thrombectomy (EVT) is unknown. We performed a retrospective cohort study of consecutive patients undergoing EVT for acute ischemic stroke at a tertiary care center between 1 January 2020 and 5 May 2025. GLP-1 RA use was defined as documented active therapy at hospital presentation. The primary outcome was aspiration pneumonia within 30 days of EVT. Secondary outcomes included symptomatic intracranial hemorrhage (sICH) and 90-day functional outcome (modified Rankin Scale, mRS). Propensity score matching was used to reduce covariate imbalances. A total of 740 patients were included, of whom 41 (5.5%) were receiving GLP-1 RAs. Aspiration pneumonia occurred more frequently among GLP-1 RA users than non-users (26.8% vs 10.3%; absolute risk difference 16.5%). GLP-1 RA use was associated with higher odds of aspiration pneumonia in both unmatched (OR 3.19, 95% CI 1.54 to 6.64; p=0.001) and matched analyses (adjusted OR 3.25, 95% CI 1.43 to 7.40; p=0.008). Rates of sICH were similar (4.9% vs 9.1%; OR 0.32, 95% CI 0.04 to 2.53; p=0.28), as were 90-day functional outcomes (common OR 1.14, 95% CI 0.58 to 2.25; p=0.70) in the matched analyses. Pre-stroke GLP-1 RA use was associated with increased aspiration pneumonia risk following EVT without differences in hemorrhagic complications or functional outcomes. These findings support targeted aspiration-prevention strategies while reinforcing that EVT should not be withheld based on GLP-1 RA exposure alone.

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