J Stroke.  2023 Jan;25(1):119-125. 10.5853/jos.2022.02334.

Mechanical Thrombectomy for Acute Ischemic Stroke in Metastatic Cancer Patients: A Nationwide Cross-Sectional Analysis

Affiliations
  • 1Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
  • 2Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
  • 3Department of Internal Medicine, CHI St. Alexius Health, Bismark, ND, USA
  • 4Department of Internal Medicine, Lincoln Medical and Mental Health Center, New York, NY, USA
  • 5Cardiovascular Medicine Department, University of Toledo, Toledo, OH, USA
  • 6Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL, USA
  • 7Departments of Neurology and Neurosurgery, New York Medical College, Valhalla, NY, USA

Abstract

Background and Purpose
Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials.
Methods
We searched the National Readmission Database for LVO patients treated with MT between 2016–2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders.
Results
Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P<0.001). Patients with MC had similar rates of intracerebral hemorrhage (20% vs. 21%) but were less likely to receive tissue plasminogen activator (13% vs. 23%, P<0.001). In unadjusted analysis, MC patients as compared to cancer-free patients had a higher in-hospital mortality rate and were less likely to be discharged to home (36% vs. 42%, P=0.014). On multivariate regression adjusting for confounders, mortality was the only outcome that was significantly higher in the MC group than in the cancerfree group (P<0.001).
Conclusion
LVO patients with MC have higher mortality and more infectious and thrombotic complications than cancer-free patients. MT nonetheless can result in survival with good outcome in slightly over one-third of patients.

Keyword

Stroke; Cancer; Metastases; Thrombectomy; Database

Figure

  • Figure 1. Cascade diagram showing patient grouping. Of all acute ischemic stroke (AIS) patients who underwent thrombectomy, the primary analysis compared 933 patients with 38,166 patients with no cancer. The 1,438 patients with a cancer diagnosis but no metastases were excluded. The secondary analysis of metastatic cancer patients compared the 933 thrombectomy-treated patients with 25,731 patients treated medically for AIS.


Reference

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