Abstract 3158: Presence of Underlying Metastatic Malignancy Increases the Risk of Intracerebal Hemorrhage after Endovascular Treatment of Acute Ischemic Stroke.

Abstract

Background: The effect of pre-existing malignancy with or without metastasis on angiographic and clinical success of endovascular treatment in acute ischemic stroke patients has not been previously studied. The procoagulant states in patients with pre-existing malignancy may lead to suboptimal results after endovascular treatment. Objective: To determine the effect of underlying malignancy with or without metastasis on angiographic recanalization and clinical outcomes among acute ischemic stroke patients undergoing endovascular treatment. Methods: We reviewed consecutive acute ischemic stroke patients treated with endovascular treatment over a 5-year period. Demographics characteristics, NIHSS score before and after the procedure, and discharge modified Rankin scale (mRS) were collected. An improvement of 1 point or more on the Qureshi grading scale was used to define angiographic recanallization. Primary malignancy and evidence of metastasis was obtained by individual chart review. We analyzed whether the presence of malignancy with or without metastasis was associated with angiographic recanalization, favorable clinical outcome, intra-cerebral hemorrhage (ICH), and length of stay (LOS) after age and NIHSS score adjustment. Results: We analyzed 186 patients undergoing endovascular treatment, mean age + SD: 65+16 years, 100(54%) men, and mean admission NIHSS score ± SD: 15.3+8. Of these, 34 patients (18%) had underlying malignancy [20 were men] with 16 patients with documented metastatic disease. The mean age was higher in the malignancy group (72 versus 64 years, p=0.014). LOS was similar (11 days versus 9, p=NS). Adjusting for age and admission NIHSS score, regression analysis showed no impact from malignancy with or without metastatic disease on recanalization rate (odds ratio [OR]=0.5, p=NS) or discharge mRS (p=NS). A total of 37 patients developed ICH after endovascular therapy (38% and 18% in patients with or without underlying malignant disease, respectively). The presence of malignancy wih or without metastatic disease was associated with significantly higher ICH rates (OR=3, p=0.05) after endovascular treatment. Conclusion: Underlying malignancy with or without metastasis in patients undergoing endovascular procedure for acute ischemic stroke is not associated with lower rates of angiographic recanalization or poor outcomes but increases the rates of post-procedural ICH by 3 fold.