Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome

Lee, Eung Joon; Bae, Jeonghoon; Jeong, Hae Bong; Lee, Eun Ji; Jeong, Hawoong; Yoon, Byung Woo

doi:10.1186/s12883-021-02086-y

Cited by 36 publications

(72 citation statements)

References 47 publications

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“…The mRS is a 7-point scale that measures the degree of disability in patients with stroke, with a score of 6 indicating death and 0 indicating good recovery without symptoms. It has been widely regarded in the literature that mRS B 2 reflects independence while mRS [ 2 implies dependence [13][14][15][16]. In this study, unfavorable outcome was defined as an mRS score of 3-6 at 12 months post-surgery and favorable outcome as an mRS score of B 2 at 12 months.…”

Section: Medical Procedures and Assessmentsmentioning

confidence: 99%

Prognostic Value of Circadian Brain Temperature Rhythm in Basal Ganglia Hemorrhage After Surgery

Huang

Kuo

2021

Neurol Ther

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Introduction: Intracerebral hemorrhage (ICH) is associated with high mortality and morbidity rates. However, both the rhythmic variation and prognostic value of brain temperature after ICH remain unknown. In this study, we investigated brain temperature rhythm and its prognostic value for post-operative mortality and long-term functional outcomes in patients with ICH. Methods: Post-operative diurnal brain temperature patterns at the basal ganglion are described. Following surgery for ICH, 78 patients were enrolled, and intracranial pressure and brain temperature were monitored using a fiber optic device. Brain temperature mesor, amplitude, and acrophase were estimated from the recorded temperature measurements, using cosinor analysis, and the association between these patterns and clinical parameters, mortality, and functional outcomes at the 12-month follow-up were examined. Results: According to cosinor analysis, brain temperature in 55.1% of patients showed a circadian rhythm within 72 h post-surgery. The rhythm-adjusted mesor of brain temperature (± standard deviation) was 37.6 (± 0.7) °C, with a diminished mean amplitude. A temperature acrophase shift was also observed. Multivariate logistic regression analysis revealed that initial age and circadian rhythm of brain temperature appeared to be predictive and prognostic of functional outcomes. Further, patients with higher brain temperature mesor were more likely to survive than those with a lower mesor. Conclusion: For patients with ICH, brain temperature rhythm analysis is an improved prognostic tool for mortality and functional outcome predictions.

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Section: Medical Procedures and Assessmentsmentioning

confidence: 99%

Prognostic Value of Circadian Brain Temperature Rhythm in Basal Ganglia Hemorrhage After Surgery

Huang

Kuo

2021

Neurol Ther

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“…All of the included studies were retrospective analyses of either files/databases of patients that received acute treatment for AIS [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], or analyses of hospital records with the use of diagnostic codes, e.g., ICD codes for AIS and malignancy [ 20 , 21 , 22 ]. One study was a retrospective analysis of cancer patients from the MR CLEAN thrombectomy study registry [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

Mechanical Thrombectomy for Acute Ischemic Stroke in Patients with Malignancy: A Systematic Review

Aloizou

Richter

James

et al. 2022

JCM

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Background: Ischemic stroke is a common occurrence in patients with concomitant malignancy. Systemic thrombolysis is often contraindicated in these patients, and mechanical thrombectomy (MT) is the preferred method of intervention. This review aims to collect the available data on the safety and efficacy of MT in cancer patients (CPs).Methods: The PubMed/MEDLINE and SCOPUS databases were systematically searched for studies assessing safety (mortality, intracranial hemorrhage) and efficacy (reperfusion, functional outcome) indices in CPs receiving MT. Potentially relevant parameters examined in solitary studies were also extracted (e.g., stroke recurrence, brain malignancy).Results: A total of 18 retrospective studies of various methodologies and objectives were identified. Rates of in-hospital mortality, intracranial hemorrhage of any kind, reperfusion rates, and discharge condition did not seem to present any considerable differences between CPs and patients without cancer. On the contrary, 90-day mortality was higher and 90-day functional independence was lower in CPs. Three studies on cancer-related stroke (no other identifiable etiology and high D-dimer levels in the presence of active cancer) showed constant tendencies towards unfavorable conditions. Conclusions: Per the available evidence, MT appears to be a safe treatment option for CPs. It is still unclear whether the 90-day mortality and outcome rates are more heavily influenced by the malignancy and not the intervention itself, so MT can be considered in CPs with prospects of a good functional recovery, undertaking an individualized approach.

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“…Javaslatok az ischaemiás stroke kezelésére malignus daganatos betegekben a jelenlegi irányelvek alapján [ A mechanikus thrombectomia vonatkozásában Koreából és Olaszországból közöltek kisebb esetsorozatokat. Lee és mtsai 2014 és 2020 között végzett 341 beavatkozást elemeztek: a betegek közül 34 volt daganatos (kizárták a hematológiai és a központi idegrendszeri daganatokat), és nem találtak statisztikai különbséget a thrombectomia akut eredményességében [21]. A 34, daganatos betegben a daganat nélküli kontrollcsoporthoz képest gyakoribb volt a vérzéses szövődmény a thrombectomia után (41,2%, míg a kontrollban 23,8%, p = 0,037), és a késői funkcionális állapot is rosszabb volt [21].…”

Section: Táblázatunclassified

“…Lee és mtsai 2014 és 2020 között végzett 341 beavatkozást elemeztek: a betegek közül 34 volt daganatos (kizárták a hematológiai és a központi idegrendszeri daganatokat), és nem találtak statisztikai különbséget a thrombectomia akut eredményességében [21]. A 34, daganatos betegben a daganat nélküli kontrollcsoporthoz képest gyakoribb volt a vérzéses szövődmény a thrombectomia után (41,2%, míg a kontrollban 23,8%, p = 0,037), és a késői funkcionális állapot is rosszabb volt [21]. A 34, daganatos betegből 3 hónappal a thrombectomia után 23-nál volt kedvezőtlen a kimenetel (mRS≥3).…”

Section: Táblázatunclassified

“…A 34, daganatos betegből 3 hónappal a thrombectomia után 23-nál volt kedvezőtlen a kimenetel (mRS≥3). Ezen betegeknél a kedvező kimenetelű 11 beteghez képest a D-dimer-szint jelentősen magasabb volt (medián 16,9 vs. 10,7), a stroke a kórházi felvételi NIHSS-pontszám alapján súlyosabb volt (medián NIHSS-pontszám 20 vs. 9), és gyakoribb volt a hasnyálmirigytumor [21].…”

Section: Táblázatunclassified

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A malignus daganatok és az ischaemiás stroke kapcsolata.

Hajnóczky

Bereczki

2022

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Összefoglaló. A malignus daganatok és a stroke együttesen gyakran fordulnak elő a stroke tradicionális rizikófaktoraival (magas vérnyomás, hyperlipidaemia, cukorbetegség, elhízás, dohányzás) rendelkező betegekben. Az elmúlt évtized kutatási eredményei alátámasztották, hogy a rosszindulatú daganatban szenvedő betegekben szignifikánsan nagyobb a stroke kockázata. A malignus daganatokhoz társuló stroke a leggyakrabban a malignus daganat diagnózisát követő fél–egy év során jelentkezik. A kapcsolat a másik irányban is létezik: stroke-betegek követése során malignus daganat szignifikánsan gyakrabban jelent meg, mint a stroke-mentes kontrollcsoportban. A daganatot a leginkább a stroke utáni első hat hónapban diagnosztizálják. A korábban nem ismert rosszindulatú daganat időnként az akut stroke kezelése során derül ki. Ismeretlen eredetű stroke (cryptogen stroke) hátterében rosszindulatú tumorhoz társuló hiperkoagulabilitás is feltételezhető. A háttérben a leggyakrabban tüdőrák áll, ezt az emlőcarcinoma és a melanoma követi. Jelenleg nincs ajánlás a felismert malignus daganatok esetében a stroke primer prevenciójára. A malignus tumor mellett jelentkező akut ischaemiás stroke kezelésére a rekombináns szöveti plazminogénaktivátorral történő intravénás thrombolysis alkalmazható a várható túlélés és a vérzésveszély mérlegelésével; a mechanikus thrombectomia alkalmazásáról kevés az adat, irányelvszintű ajánlások még nincsenek. A másodlagos stroke-prevencióra a kis molekulasúlyú heparinnal történő antikoagulálást javasolják. Jelenleg még nem ismerjük pontos részleteiben a daganat által okozott hiperkoaguláció mechanizmusát, ezért még nem ismert, hogy mi a legjobb módszer tumoros betegeknél a stroke megelőzésére. Nincsenek jól definiált ajánlások arra sem, hogy milyen esetekben lenne indokolt tumorkeresés cryptogen stroke-os betegekben. Orv Hetil. 2022; 163(2): 43–51. Summary. Cancer and stroke occur in similar patient populations, and they have similar traditional risk factors (hypertension, hyperlipidemia, obesity, diabetes, and smoking), therefore, it is beneficial to study the relationship between cancer and stroke. Patients diagnosed with cancer have an increased incidence of acute ischemic cerebral events within the first 6 months up to a year post diagnosis. The reverse relationship is also true for patients diagnosed with stroke and then cancer. Interestingly, patients may have a stroke as their first indication to an underlying developing cancer and will most often be diagnosed with cancer sometime within six months to a year after the cerebral incident. When cancer is diagnosed immediately after a cryptogenic stroke (unknown etiology), the stroke may be a result of cancer-associated hypercoagulability. The most common malignancies observed in the cancer-stroke patients are lung, breast and melanoma. Currently, there are no pharmacologic recommendations for primary stroke prevention in cancer patients. For acute ischemic stroke, life expectancy and the potential for hemorrhagic complications should be considered when deciding on thrombolytic treatment. Only a few case series have been reported on mechanical thrombectomy in malignancies, and there are no guideline recommendations yet. Secondary prevention is advised through low molecular weight heparin. Understanding cancer-associated hypercoagulability and the ways we can prevent the combined effects of cancer and stroke is a crucial gap that requires further studies. Additionally, guides to aid in the recognition of underlying malignancy in patients suffering from cryptogenic stroke need to be established. Orv Hetil. 2022; 163(2): 43–51.

show abstract

Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome

Cited by 36 publications

References 47 publications

Prognostic Value of Circadian Brain Temperature Rhythm in Basal Ganglia Hemorrhage After Surgery

Prognostic Value of Circadian Brain Temperature Rhythm in Basal Ganglia Hemorrhage After Surgery

Mechanical Thrombectomy for Acute Ischemic Stroke in Patients with Malignancy: A Systematic Review

A malignus daganatok és az ischaemiás stroke kapcsolata.

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