Ischemic stroke in cancer patients: A review of an underappreciated pathology

Navi, Babak B.; Iadecola, Costantino

doi:10.1002/ana.25227

Cited by 200 publications

(232 citation statements)

References 84 publications

(284 reference statements)

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“…Other potential mechanisms of stroke in cancer disease include nonbacterial endocarditis, paradoxical embolism, tumor embolism, vasculitis, and vascular compression by masses or vessel wall infiltration. Importantly, recurrence rates are high, ranging from 13% to 28%, and correlating with increased D‐dimer levels . A multi‐territory scattering lesion pattern on DWI sequences of brain MRI is more frequently encountered and is representative of the intense microembolism .…”

Section: Cancermentioning

confidence: 99%

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

Kargiotis

Psychogios

Safouris

et al. 2019

Journal of Neuroimaging

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Acute multi‐territory, embolic cerebral infarctions are often associated with serious underlying clinical conditions including the presence of highly “active” emboligenic sources causing that in turn may result in high early recurrence rates. Prompt diagnosis, risk stratification, and treatment are substantial for the prevention of subsequent embolization that would result in further clinical deterioration. Among other clinical investigations, transcranial Doppler (TCD) monitoring is highly efficacious for the detection of microembolic signals (MES) that correspond to microthrombi entering the intracranial circulation. The presence and burden of MES, especially in multiple intracranial arteries, is clearly associated with an increased risk of symptomatic, recurrent embolization, and thus can justify a more aggressive treatment approach (clopidogrel load followed by dual antiplatelet therapy or alternatively therapeutic dose of low‐molecular‐weight heparin). In this narrative review, we discuss the most important causes of multi‐territory embolic ischemic strokes and also underscore the utility of TCD as a noninvasive tool for the diagnosis, risk stratification, and treatment.

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Section: Cancermentioning

confidence: 99%

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

Kargiotis

Psychogios

Safouris

et al. 2019

Journal of Neuroimaging

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“…5 A Danish registry-based case-control study with over 264 000 cancer patients also showed an approximately 2-fold risk for ischemic stroke in occult cancers. 8 Cancer can also cause marantic (non-bacterial) endocarditis, mechanical compression of critical vessels, anemia, and tumor embolism. However, lung, pancreatic, and colorectal cancers seem to have a higher association with ischemic stroke, perhaps due to their aggressiveness.…”

mentioning

confidence: 99%

“…6 No solid data exist on exact prevalence of different cancer types in ischemic stroke patients. 8,9 Other potential mechanisms that increase the risk of ischemic stroke in the presence of cancer include endothelium dysfunction and abnormalities in turbulence in abnormal blood vessels. 7 Other reported common cancer types include breast, urogenital and prostate cancers.…”

mentioning

confidence: 99%

“…However, lung, pancreatic, and colorectal cancers seem to have a higher association with ischemic stroke, perhaps due to their aggressiveness. 8,9 In cancer-associated ischemic stroke, several factors, such as elevated D-dimer and specific cancer types (especially adenocarcinomas), are also associated with an increased early neurologic deterioration, recurrent strokes, and other types of thromboembolism. 7 Cancer and ischemic stroke share multiple common risk factors such as age, obesity, and smoking.…”

mentioning

confidence: 99%

“…7 Cancer and ischemic stroke share multiple common risk factors such as age, obesity, and smoking. 8 Hence, patients harboring an active cancer and admitted with an acute stroke is a common scenario. Despite that, up to 50% of ischemic strokes occurring in patients harboring a cancer are considered cryptogenic.…”

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confidence: 99%

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Cancer‐associated ischemic stroke

Martinez‐Majander

Tatlısumak

2020

Acta Neurol Scand

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Association of Stroke at Young Age With New Cancer in the Years After Stroke Among Patients in the Netherlands

et al. 2023

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ImportanceStroke may be a first manifestation of an occult cancer or may be an indicator of an increased cancer risk in later life. However, data, especially for younger adults, are limited.ObjectivesTo assess the association of stroke with new cancer diagnoses after a first stroke, stratified by stroke subtype, age, and sex, and to compare this association with that in the general population.Design, Setting, and ParticipantsThis registry- and population-based study included 390 398 patients in the Netherlands aged 15 years or older without a history of cancer and with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) between January 1, 1998, and January 1, 2019. Patients and outcomes were identified through linkage of the Dutch Population Register, the Dutch National Hospital Discharge Register, and National Cause of Death Register. Reference data were gathered from the Dutch Cancer Registry. Statistical analysis was performed from January 6, 2021, to January 2, 2022.ExposureFirst-ever ischemic stroke or ICH. Patients were identified by administrative codes from the International Classification of Diseases, Ninth Revision, and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.Main Outcomes and MeasuresThe primary outcome was the cumulative incidence of first-ever cancer after index stroke, stratified by stroke subtype, age, and sex, compared with age-, sex- and calendar year–matched peers from the general population.ResultsThe study included 27 616 patients aged 15 to 49 years (median age, 44.5 years [IQR, 39.1-47.6 years]; 13 916 women [50.4%]; 22 622 [81.9%] with ischemic stroke) and 362 782 patients aged 50 years or older (median age, 75.8 years [IQR, 66.9-82.9 years]; 181 847 women [50.1%]; 307 739 [84.8%] with ischemic stroke). The cumulative incidence of new cancer at 10 years was 3.7% (95% CI, 3.4%-4.0%) among patients aged 15 to 49 years and 8.5% (95% CI, 8.4%-8.6%) among patients aged 50 years or older. The cumulative incidence of new cancer after any stroke among patients aged 15 to 49 years was higher among women than men (Gray test statistic, 22.2; P &lt; .001), whereas among those aged 50 years or older, the cumulative incidence of new cancer after any stroke was higher among men (Gray test statistic, 943.1; P &lt; .001). In the first year after stroke, compared with peers from the general population, patients aged 15 to 49 years were more likely to receive a diagnosis of a new cancer after ischemic stroke (standardized incidence ratio [SIR], 2.6 [95% CI, 2.2-3.1]) and ICH (SIR, 5.4 [95% CI, 3.8-7.3]). For patients aged 50 years or older, the SIR was 1.2 (95% CI, 1.2-1.2) after ischemic stroke and 1.2 (95% CI, 1.1-1.2) after ICH.Conclusions and RelevanceThis study suggests that, compared with the general population, patients aged 15 to 49 years who have had a stroke may have a 3- to 5-fold increased risk of cancer in the first year after stroke, whereas this risk is only slightly elevated for patients aged 50 years or older. Whether this finding has implications for screening remains to be investigated.

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Ischemic stroke in cancer patients: A review of an underappreciated pathology

Cited by 200 publications

References 84 publications

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

Cancer‐associated ischemic stroke

Association of Stroke at Young Age With New Cancer in the Years After Stroke Among Patients in the Netherlands

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