Histological features of intracranial thrombi in stroke patients with cancer

Park, Hyungjong; Kim, Jayoung; Ha, Jimin; Hwang, In Gun; Song, Tae Jin; Yoo, Joonsang; Ahn, Seong Hwan; Kim, Kyoungsub; Kim, Byung Moon; Kim, Dong Joon; Kim, Young Dae; Nam, Hyo Suk; Kwon, Il; Choi, Hyun Jung; Sohn, Sung Il; Lee, Hye Sun; Heo, Ji Hoe

doi:10.1002/ana.25495

Cited by 66 publications

(78 citation statements)

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“…Because the study participants had active cancer, patients were categorized into those with NBTE, those with cryptogenic etiology, and those with determined etiology [ 11 ]. NBTE was determined based on formal reports by cardiologists who diagnosed vegetation based on echocardiographic examinations.…”

Section: Methodsmentioning

confidence: 99%

“…However, pathological studies have shown that the vegetation and thrombi retrieved from stroke patients with NBTE have very high platelet fractions. 10,11 Further, cancer is known to activate platelets, which play an important role in metastasis. 12 These findings suggest a potential association between NBTE and metastasis.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the pathomechanism of NBTE is unknown. However, pathological studies have shown that the vegetation and thrombi retrieved from stroke patients with NBTE have very high platelet fractions [ 10 , 11 ]. Further, cancer is known to activate platelets, which play an important role in metastasis [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis

et al. 2020

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Background and Purpose Nonbacterial thrombotic endocarditis (NBTE) is a cause of stroke in cancer. However, clinical characteristics and outcomes in stroke patients with cancer-associated NBTE are not well known.<br/>Methods We included consecutive patients with stroke and active cancer over a 9-year period who underwent echocardiography. We retrospectively compared clinical characteristics and presence of metastasis between patients with NBTE, those with cryptogenic etiologies, and those with determined etiologies. We also investigated mortality and stroke events during the 6-month follow-up.<br/>Results Among the 245 patients, 20 had NBTE, 96 had cryptogenic etiologies, and 129 had determined etiologies. Metastasis was seen in all 20 patients (100%) with NBTE, 69.8% in patients with cryptogenic etiology, and 48.8% in patients with or determined etiology. During the 6-month follow-up, 127 patients (51.8%) developed stroke and/or died (death in 110 [44.9%] and stroke events in 55 [22.4%]). Patients with NBTE showed significantly higher mortality (80%) and stroke occurrence (50%) than those with cryptogenic etiologies (mortality 54.2%, stroke 25.0%, log-rank P=0.006) and determined etiologies (mortality 32.6%, stroke 16.3%, log-rank P<0.001). In a multivariate Cox proportional hazard analysis, the presence of NBTE was independently associated with composite outcomes of mortality and stroke events (hazard ratio, 1.941; 95% confidence interval, 1.052 to 3.690).<br/>Conclusions NBTE should be suspected as a potential cause of stroke in patients with metastatic cancer. Patients with NBTE have a high risk of recurrent stroke and mortality. Future studies are necessary to determine strategies to reduce stroke recurrence in patients with NBTE.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis

et al. 2020

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“…1 / January 2020 cancer-related stroke. 77 However, further studies with a larger cohort are needed and a recent study showed that although retrieved thrombi may provide useful information on the treatment strategy, the components of retrieved thrombi could be changed during the thrombectomy procedure. 78…”

Section: Prevention Of Stroke In Cancer Coagulopathymentioning

confidence: 99%

Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms

et al. 2020

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Systemic cancer and ischemic stroke are common conditions and two of the most frequent causes of death among the elderly. The association between cancer and stroke has been reported worldwide. Stroke causes severe disability for cancer patients, while cancer increases the risk of stroke. Moreover, cancer-related stroke is expected to increase due to advances in cancer treatment and an aging population worldwide. Because cancer and stroke share risk factors (such as smoking and obesity) and treatment of cancer can increase the risk of stroke (e.g., accelerated atherosclerosis after radiation therapy), cancer may accelerate conventional stroke mechanisms (i.e., atherosclerosis, small vessel disease, and cardiac thrombus). In addition, active cancer and chemotherapy may enhance thrombin generation causing stroke related to coagulopathy. Patients with stroke due to cancer-related coagulopathy showed the characteristics findings of etiologic work ups, D-dimer levels, and infarct patterns. In this review, we summarized the frequency of cancer-related stroke among patients with ischemic stroke, mechanisms of stroke with in cancer patients, and evaluation and treatment of cancer-related stroke. We discussed the possibility of cancer-related stroke as a stroke subtype, and presented the most recent discoveries in the pathomechanisms and treatment of stroke due to cancer-related coagulopathy.

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“…A comparable reduction of NIHSS values was reported in a recent meta-analysis on the outcome of thrombectomy after large vessel ischaemic stroke (baseline NIHSS score of 17 and 10.4 after 24 h [15] compared to initial median NIHSS score of 15 on admission and 7 within the first 24 h in our study, Table 1). Another recent cohort study reported distinct histopathological features of clots from thrombectomy in patients with active and inactive cancer compared to non-cancer controls [16]. However, additional tumor-specific stainings were not performed and tumor cells might have been missed.…”

Section: Discussionmentioning

confidence: 99%

Embolization of tumor cells is rare in patients with systemic cancer and cerebral large vessel occlusion

Wolpert

Kulcsár

Hänsel

et al. 2020

Euro J of Neurology

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Background and purpose Stroke is a dreaded complication in patients with cancer. Besides paraneoplastic coagulopathy, chemotherapy, radiotherapy and tumor‐directed invasive procedures, circulating cancer cells may contribute to thrombus formation and embolic stroke. However, the incidence of tumor cells within the blood clots of cancer patients with stroke is unknown and the role of circulating tumor cells in the formation of cerebrovascular thrombi remains unclear. Methods All patients who had undergone cerebrovascular thrombectomy at the University Hospital Zurich between 2014 and 2017 were screened for history of cancer. Clinical information was retrieved from the local stroke registry and the electronic charts and thrombi underwent a thorough histopathological re‐review. Results Thirty‐two of 182 patients (18%) with thrombectomy had a history of cancer. The majority of patients had advanced stage cancer. However, even after extensive histopathological re‐review, only one specimen revealed tumor cells in the thrombus: a 75‐year‐old patient with acute occlusion of the middle cerebral artery who had been diagnosed with non‐small‐cell lung cancer 8.1 months prior to stroke. Conclusions The presence of cancer cells in clots from cerebrovascular thrombectomy, indicative of a direct involvement of circulating tumor cells in the causation of stroke, is rare.

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Histological features of intracranial thrombi in stroke patients with cancer

Abstract: View this article online at wileyonlinelibrary.com.

Cited by 66 publications

References 20 publications

Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis

Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis

Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms

Embolization of tumor cells is rare in patients with systemic cancer and cerebral large vessel occlusion

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