Research Article| Volume 31, ISSUE 6, 106439, June 2022

Download started.


Endovascular Therapy is Effective for Large Vessel Occlusion Despite Concurrent Cancer



      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.


      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.


      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Navi BB
        • Reiner AS
        • Kamel H
        • et al.
        Risk of arterial thromboembolism in patients with cancer.
        J Am Coll Cardiol. 2017; 70: 926-938
        • Navi BB
        • Iadecola C
        Ischemic stroke in cancer patients: a review of an underappreciated pathology.
        Ann Neurol. 2018; 83: 873-883
        • Grisold W
        • Oberndorfer S
        • Struhal W
        Stroke and cancer: a review.
        Acta Neurol Scand. 2009; 119: 1-16
        • Powers WJ
        • Rabinstein AA
        • Ackerson T
        • et al.
        Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
        Stroke. 2019; 50: e344-e418
        • Belt RJ
        • Leite C
        • Haas CD
        • Stephens RL
        Incidence of Hemorrhagic Complications in Patients With Cancer.
        Jama. 1978; 239
        • Adams Jr., HP
        • Bendixen BH
        • Kappelle LJ
        • et al.
        Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.
        Stroke. 1993; 24: 35-41
        • Chaturvedi S AJ
        • Recht L
        Should cerebral ischemic events in cancer patients be considered a manifestation of hypercoagulability?.
        Stroke. 1994; 25: 1215-1218
        • Navi BB
        • Marshall RS
        • Bobrow D
        • et al.
        Enoxaparin vs aspirin in patients with cancer and ischemic stroke: the TEACH pilot randomized clinical trial.
        JAMA Neurol. 2018; 75: 379-381
        • Cho BH
        • Yoon W
        • Kim JT
        • et al.
        Outcomes of endovascular treatment in acute ischemic stroke patients with current malignancy.
        Neurol Sci. 2020; 41: 379-385
        • Jung S
        • Jung C
        • Hyoung Kim J
        • et al.
        Procedural and clinical outcomes of endovascular recanalization therapy in patients with cancer-related stroke.
        Interv Neuroradiol. 2018; 24: 520-528
        • Lee EJ
        • Bae J
        • Jeong HB
        • Lee EJ
        • Jeong HY
        • Yoon BW
        Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome.
        BMC Neurol. 2021; 21: 57
        • Jeon Y
        • Baik SH
        • Jung C
        • et al.
        Mechanical thrombectomy in patients with acute cancer-related stroke: is the stent retriever alone effective?.
        J Neurointerv Surg. 2021; 13: 318-323
        • Lee D
        • Lee DH
        • Suh DC
        • et al.
        Intra-arterial thrombectomy for acute ischaemic stroke patients with active cancer.
        J Neurol. 2019; 266: 2286-2293
        • Oki S
        • Kawabori M
        • Echizenya S
        • et al.
        Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy.
        Front Neurol. 2020; 11572589
        • Ciolli L
        • Bigliardi G
        • Ferraro D
        • et al.
        Efficacy of mechanical thrombectomy in patients with ischemic stroke and cancer.
        J Clin Neurosci. 2021; 91: 20-22
        • Yoo J
        • Kim YD
        • Park H
        • et al.
        Immediate and Long-Term Outcomes of Reperfusion Therapy in Patients With Cancer.
        Stroke. 2021; 52: 2026-2034
        • Naito H
        • Nezu T
        • Hosomi N
        • et al.
        Antithrombotic Therapy Strategy for Cancer-Associated Ischemic Stroke: A Case Series of 26 Patients.
        J Stroke Cerebrovasc Dis. 2018; 27: e206-e211
        • Cutting S
        • Wettengel M
        • Conners JJ
        • Ouyang B
        • Busl K
        Three-Month Outcomes Are Poor in Stroke Patients with Cancer Despite Acute Stroke Treatment.
        J Stroke Cerebrovasc Dis. 2017; 26: 809-815
        • Merkler AE
        • Marcus JR
        • Gupta A
        • et al.
        Endovascular Therapy for acute stroke in patients with cancer.
        Neurohospitalist. 2014; 4: 133-135
        • Kuroda N
        • Hiramatsu H
        • Mori M
        • Tanaka T
        Mechanical Thrombectomy for Trousseau Syndrome in a Terminally Ill Cancer Patient.
        J Pain Symptom Manage. 2019; 57: 688-694
        • Wassef C
        • Grenga A
        • Goldman B
        • Mattingly T
        Triple Thrombectomy for Trousseau Syndrome: Case Report and Review of the Literature of Stroke Intervention in Cancer-associated Thrombus.
        Journal of Neuroendovascular Therapy. 2020; 14: 301-306
        • Lee EJ
        • Nah HW
        • Kwon JY
        • Kang DW
        • Kwon SU
        • Kim JS
        Ischemic stroke in patients with cancer: is it different from usual strokes?.
        Int J Stroke. 2014; 9: 406-412
        • Shinohara T
        • Tsumura M
        • Hasegawa A
        • Yamanaka Y
        A Case of Mechanical thrombectomy for middle cerebral artery occlusion with trousseau syndrome.
        Journal of Neuroendovascular Therapy. 2017; 11: 485-491
        • Matsumoto N
        • Fukuda H
        • Handa A
        • et al.
        Histological Examination of Trousseau Syndrome-Related Thrombus Retrieved Through Acute Endovascular Thrombectomy: Report of 2 Cases.
        J Stroke Cerebrovasc Dis. 2016; 25: e227-e230
        • Jang H
        • Lee JJ
        • Lee MJ
        • et al.
        Comparison of Enoxaparin and Warfarin for Secondary Prevention of Cancer-Associated Stroke.
        J Oncol. 2015; 2015502089
        • Kim SJ
        • Park JH
        • Lee MJ
        • Park YG
        • Ahn MJ
        • Bang OY
        Clues to occult cancer in patients with ischemic stroke.
        PLoS One. 2012; 7: e44959
      1. US Cancer statistics data visualizations tool. 2019.

        • Lee M CJ
        • Ahn M
        • Kim S
        • Seok J
        • Jang H
        • Kim G
        • Chung C
        • Lee K
        • Bang O
        Hypercoagulability and mortality of patients with stroke and active cancer: the OASIS-CANCER study.
        Journall of Stroke. 2017; 19: 77-87
        • Hsu JY
        • Liu AB
        Anticoagulants for cancer-associated ischemic stroke.
        Ci Ji Yi Xue Za Zhi. 2019; 31: 144-148
        • Kawano H
        • Honda Y
        • Amano T
        • et al.
        Subcutaneous Heparin Therapy for Patients with Cancer-Associated Stroke.
        J Stroke Cerebrovasc Dis. 2019; 28: 399-404
        • Key NS
        • Khorana AA
        • Kuderer NM
        • et al.
        Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update.
        J Clin Oncol. 2020; 38: 496-520