Abstract 308: Inpatient Optimization of Endovascular Therapy for Acute Ischemic Stroke in Patients with Active Malignancy

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Introduction Landmark trials studying the efficacy of endovascular therapy for patients with large vessel occlusions generally excluded patients with active cancer. Of those with malignancy undergoing mechanical thrombectomy, they tend to have worse clinical outcomes despite technical success. Thus, implications of mechanical thrombectomy in this cohort remains debated. Our objective is to elucidate post thrombectomy outcomes in patients with active cancer to further optimize inpatient management. Methods We conducted a retrospective cohort study of stroke thrombectomy cases performed at our institution from January 2010 to March 2024. Pearson Chi‐square test and Fisher's exact test were used to analyze categorical variables, and Mann‐Whitney U tests were used for continuous variables. Multivariable logistic regression analyses were performed to evaluate for independent associations between baseline characteristics and study outcomes of interest, specifically, successful endovascular reperfusion (≥TICI 2b) and poor clinical outcome, defined as death or disposition to hospice. Results We identified 50 patients with active cancer who underwent mechanical thrombectomy (MT) for stroke. Mean age was 63.8 years (SD, 11.4), 48% were men, and 68% had stage IV cancer. Successful reperfusion was achieved in 78% of patients, and 50% ultimately had a poor clinical outcome, including 40% inpatient deaths. Of those that died inpatient, 46% of deaths were due to non‐neurological causes. 78% of patients undergoing MT were treated with optimal medical management post stroke with either anticoagulation or antiplatelet therapy. In total, 16% of patients went on to complete cancer treatment. While there were no pre‐EVT variables that were significantly associated with outcome change, the decision to initiate anticoagulation post‐EVT while inpatient was associated with more favorable outcomes (p=0.006). Only 6% of patients were found to have sICH, and the use of IV thrombolysis prior was not found to impact this rate. Conclusion In our study, we found that despite a high successful reperfusion rate, nearly half of cancer patients undergoing mechanical thrombectomy for large vessel occlusion strokes had a poor clinical outcome. We found that anticoagulation post thrombectomy independently correlated with a more favorable outcome. Future studies must further elucidate other factors that may influence outcomes to guide in optimal patient selection and maximize overall success of EVT in patients with cancer.