Abstract
BackgroundThe effectiveness of mechanical thrombectomy (MT) in cancer-related stroke (CRS) is largely unknown. This study aims to investigate the clinical and radiological outcomes of MT in CRS patients. We also explored the factors that independently affect functional outcomes of patients with CRS after MT.MethodsWe retrospectively reviewed 341 patients who underwent MT after acute ischemic stroke onset between May 2014 and May 2020. We classified the patients into CRS (n = 34) and control (n = 307) groups and compared their clinical details. Among CRS patients, we analyzed the groups with and without good outcomes (3-months modified Rankin scale [mRS] score 0, 1, 2). Multivariate analysis was performed to investigate the independent predictors of unfavorable outcomes in patients with CRS after MT.ResultsA total of 341 acute ischemic stroke patients received MT, of whom 34 (9.9%) had CRS. Although the baseline National institute of health stroke scale (NIHSS) score and the rate of successful recanalization was not significantly different between CRS patients and control group, CRS patients showed more any cerebral hemorrhage after MT (41.2% vs. controls 23.8%, p = 0.037) and unfavorable functional outcome at 3 months (CRS patients median 3-month mRS score 4, interquartile range [IQR] 2 to 5.25 vs. controls median 3-month mRS score 3, IQR 1 to 4, [p = 0.026]). In the patients with CRS, elevated serum D-dimer level and higher baseline NIHSS score were independently associated with unfavorable functional outcome at 3 months (adjusted odds ratio [aOR]: 1.524, 95% confidence interval [CI]: 1.043–2.226; aOR: 1.264, 95% CI: 1.010–1.582, respectively).ConclusionsMT is an appropriate therapeutic treatment for revascularization in CRS patients. However, elevated serum D-dimer levels and higher baseline NIHSS scores were independent predictors of unfavorable outcome. Further research is warranted to evaluate the significance of these predictors.
Highlights
Cerebrovascular disease affects around 15% of all patients with malignancy throughout their life
We explored the factors that were independently associated with unfavorable functional outcomes
Subjects We retrospectively reviewed the medical records of all 372 consecutive patients with acute ischemic stroke (AIS) who received mechanical thrombectomy (MT) in the Seoul National University Hospital (SNUH) between May 2014 and May 2020
Summary
Cerebrovascular disease affects around 15% of all patients with malignancy throughout their life. Patients with cancer frequently experience acute ischemic stroke (AIS) [1]. The pathophysiology of AIS in cancer is vary. Cancer-related stroke (CRS) by intravascular coagulopathy by tumor-cell derived cytokines or microparticles, is of particular concern [2, 3]. With the advancement of anti-cancer therapy, the survival period has been prolonged; CRS and the need for thrombolysis has increased [6]. The effectiveness of mechanical thrombectomy (MT) in cancer-related stroke (CRS) is largely unknown. This study aims to investigate the clinical and radiological outcomes of MT in CRS patients. We explored the factors that independently affect functional outcomes of patients with CRS after MT
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