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

Abstract

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.