Clinical features and prognostic factors in patients with cancer-associated multiple ischemic stroke: A retrospective observational study


      • Cancer-mediated hypercoagulability sometimes develops multiple ischemic strokes that involve various cerebrovascular territories (multiple CAIS).
      • In our study, multiple CAIS occurred in elderly patients with advanced cancer, mostly independent in daily living with relatively high KPS scores, but their survival was ∼1–2 months.
      • Hypoalbuminemia at the onset of multiple CAIS was significantly associated with short survival.



      To investigate the patient demographics, survival after diagnosis, and prognostic factors among patients with multiple-territory cerebral infarctions due to cancer-associated ischemic stroke (multiple CAIS).

      Materials and methods

      We performed a retrospective review of the medical records from a 10-year period of consecutive patients with multiple CAIS, defined as (1) newly developed multiple cerebral infarctions involving two or more cerebrovascular territories, (2) association with active cancer diagnosed or treated <6 months before or after stroke, and (3) exclusion of obvious etiologies other than cancer-associated coagulopathy in routine screening. We extracted demographic features, stroke severity and characteristics, cancer characteristics, comorbidities, and laboratory data. Univariable Cox proportional hazards regression was used to idenify the prognostic factors.


      The median age was 74 years (interquartile range, 68.3–80.5), and the median survival after diagnosis was 44.5 (27.3–76.8) days in 26 patients with complete follow-up. The median National Institutes of Health Stroke Scale was 5.5 (2.0–9.0). Twenty (76.9%) patients had received a cancer diagnosis prior to the diagnosis of multiple CAIS, and most patients (25 patients, 96.2%) had stage IV cancer. Univariate analysis showed that high serum albumin (hazard ratio, 0.31; 95% confidence interval, 0.11–0.88) was significantly associated with prolonged survival, whereas stroke severity and comorbidities were not associated with survival.


      Multiple CAIS predominantly occurred in elderly patients with advanced cancer, and their survival was short. Serum albumin levels were significantly associated with prognosis, indicating the poor general condition associated with cancers may affect prognosis.



      CAIS (Cancer-associated ischemic stroke), DVT (Deep vein thrombosis), ESUS (Embolic stroke of undetermined source), KPS (Karnofsy Performance Scale), mRS (modified Rankin Scale), NIHSS (National Institutes of Health Stroke Scale)
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