Abstract WP158: Trends In Utilization Of IV Thrombolysis And Mechanical Thrombectomy In Patients With Stroke And Malignancy.

Abstract

Background and Purpose: Existing data shows that IV thrombolysis (tPA) and mechanical thrombectomy (MT) use in acute ischemic stroke (AIS) patients and malignancy is <2%. Our aim was to determine whether utilization of recanalization therapies has increased in AIS patients with cancer since publication of pivotal MT trials. Methods: All admissions with a primary diagnosis of AIS (weighted n=5,554,161) were identified from the 2007-2018 Nationwide Inpatient Sample. Cancer-associated strokes (CAS) were categorized into hematologic (hem), solid and metastatic (met) cancers. Joint point regression and multivariable-adjusted logistic regression models with interaction terms were used to evaluate rate of change in t-PA and MT use in CAS compared to non-CAS admissions. Results: Across this period, 4.0% of AIS admissions had comorbid CAS. The proportion of AIS hospitalizations with CAS increased from 3.8% in 2007 to 4.4% in 2018. Mean age of CAS was 72.9 (47.6% women) vs. 70.6 years (51.8% women) among non-CAS. CAS patients had fewer vascular risk factors. Highest t-PA usage was in non-CAS pts (7.8%) and lowest use in met-CAS pts (3.8%) and this difference was significant. In contrast MT usage was highest in met-CAS (2.0%) vs non-CAS (1.6%) and hem-CAS (1.2%). A race-by-time interaction revealed an increase in utilization of both therapies in all CAS groups. Pace of the increase was slower in met CAS (OR 0.97, 95%CI 0.95-0.99) per unit increase in year. MT use increased at a faster pace in met-CAS patients (OR 1.07, 95%CI 1.02-1.12) compared to non-CAS. Although overall mortality rates for patients with cancer has decreased for all cancer types, CAS had significantly higher in hospital mortality as compared to NCS (8.9% vs 4.4%, p <0.001). Conclusions: Utilization of both t-PA and MT has increased over the last decade. Contrary to prior studies, the current frequency and pace of increase in MT use is greater in met-CAS admissions compared to non-CAS. Patients with CAS have fewer traditional vascular risk factors and significantly higher in hospital mortality. Future studies should address longer term outcomes in CAS versus non-cancer strokes.