Musmar et al. recently reported a multicenter retrospective analysis evaluating the impact of postoperative aspirin (ASA) use following treatment of intracranial aneurysms with the Woven EndoBridge (WEB) device. ^{Reference Musmar, Salim and Roy1} Their study addresses an important and unresolved question in contemporary neurointerventional practice: whether antiplatelet therapy provides additional benefit following intrasaccular flow disruption, a technique designed to minimize the need for routine antiplatelet medication.

The introduction of intrasaccular flow disruption has expanded endovascular treatment options for wide-neck bifurcation aneurysms. Among these advances, the WEB device enables treatment strategies that frequently avoid adjunctive stents and dual antiplatelet therapy. ^{Reference Arthur, Molyneux and Coon2–Reference van Rooij, Sprengers, Peluso, Sluzewski, Bechan and van Rooij4} In this context, postoperative antiplatelet management remains variable across institutions.

The most notable observation in the present study is the association between postoperative ASA use and lower retreatment rates after propensity score matching, while functional outcomes and mortality were similar between groups. ^{Reference Musmar, Salim and Roy1} The ASA cohort demonstrated significantly better functional outcomes and lower mortality before matching; however, these differences were no longer statistically significant after matching, suggesting that baseline differences may have contributed to the initial observed advantage. These findings align with increasing recognition that inflammatory pathways and thrombus organization contribute to aneurysm healing following endovascular therapy. ^{Reference Aoki, Nishimura and Matsuoka5} Aspirin-mediated inhibition of inflammatory mediators and matrix metalloproteinases may theoretically promote aneurysm stabilization and reduce recurrence. ^{Reference Aoki, Nishimura and Matsuoka5} The multicenter cohort also provides a useful real-world perspective on postoperative management patterns following WEB treatment.

As with many retrospective multicenter analyses, several methodological considerations should be considered when interpreting these findings. Postoperative aspirin administration was not standardized and was frequently continued for unrelated cardiovascular indications. While reflective of real-world practice, this introduces the possibility of residual confounding despite propensity score matching. Baseline differences between groups before matching, including a higher proportion of ruptured aneurysms in the non-ASA cohort, also highlight the challenges inherent in comparing treatment strategies in observational datasets.

The relatively small matched cohort limits statistical power and restricts detailed subgroup analyses. Follow-up duration also remains limited, and longer-term angiographic durability is an important consideration when evaluating intrasaccular flow-disruption devices, particularly given reports of delayed device compaction and aneurysm recurrence. ^{Reference Cognard and Januel6}

Ultimately, clarification of antiplatelet strategies in the era of intrasaccular flow disruption will require prospective evaluation, but studies such as this provide an important foundation for refining postoperative management following WEB therapy.