Abstract
Objectives
Ischemic stroke and concurrent cancer is increasingly recognized. However, optimal
management is uncertain. As mechanical thrombectomy has become the standard of care
for large vessel occlusion, more patients with cancer are presenting for embolectomy.
However, it is unknown whether this subgroup has the same benefit profile described
in multiple randomized trials for thrombectomy for large vessel occlusion. Our objective
was to retrospectively evaluate a North American embolectomy database for safety and
outcomes in patients with active cancer.
Materials and methods
A case series of 284 embolectomies over 30 months at a single North American stroke
center were divided into thrombectomy patients with active cancer(n=25) and those
without active cancer (n=259). We compared patient characteristics, procedural characteristics,
and procedural outcomes between patients with and without active cancer. Univariate
and multivariate analysis of angiographic outcomes, postoperative hemorrhage, and
functional outcome was performed.
Results
Of the 284 thrombectomy cases, 9% were performed on patients with active cancer. Active
cancer patients had a similar recanalization grade and post-operative hemorrhage rate,
compared to patients without cancer. Active cancer patients had a significantly higher
90 day mortality (40% vs 20%, p=0.018). On multivariate analysis, good functional
outcome (mRS 0-2) was not impacted by active cancer. However, when mRS was evaluated
as an ordinal shift analysis, worse functional outcome was associated with active
cancer (OR 2.98; 95% CI, 1.29 to 6.59), greater age, NIHSS> 10, and ASPECTS<9.
Conclusions
This single center retrospective series of active cancer patients undergoing thrombectomy
for large vessel occlusion demonstrates similar rates of recanalization, post-operative
hemorrhage, and good outcomes. While the active cancer group has a high short-term
mortality, the potential to maintain quality of life in the survivors makes thrombectomy
reasonable in this patient population. Awareness of ischemic stroke as a complication
of cancer and the safety of thrombectomy in this population are important as this
population subtype is expected to grow with improved oncology and stroke care
Key Words
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Article info
Publication history
Published online: March 18, 2022
Accepted:
February 23,
2022
Received in revised form:
February 19,
2022
Received:
October 26,
2021
Footnotes
Funding: none
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106439
Copyright
© 2022 Elsevier Inc. All rights reserved.
