Ischemic Stroke in Patients with Cancer: A Retrospective Cross-Sectional Study

Abstract

Introduction An increasing trend of cancer associated stroke has been noticed in the past decade. Objectives To evaluate the risk factors and the incidence of neoplasia in stroke patients. Material and Method A retrospective, observational study was undertaken on 249 patients with stroke and active cancer (SAC) and 1563 patients with stroke without cancer (SWC). The general cardiovascular risk factors, the site of cancer, and the general clinical data were registered and evaluated. According to the “Oxfordshire Community Stroke Project” (OCSP) classification, all patients were classified into the clinical subtypes of stroke. The aetiology of stroke was considered as large-artery atherosclerosis, small vessel disease, cardio-embolic, cryptogenic or other determined cause. Results The severity of neurological deficits at admission were significantly higher in the SAC group (p<0.01). The haemoglobin level was significantly lower, and platelet level and erythrocyte sedimentation rate were significantly higher in the SAC group. Glycaemia, cholesterol and triglycerides levels were significantly higher in the SWC group. The personal history of hypertension was more frequent in the SWC group. In the SAC group, 28.9% had a cryptogenic aetiology, compared to 9.1% in SWC group. Cardio-embolic strokes were more frequent in the SAC group (24%) than the SWC group (19.6%). In the SAC group, 15,6% were diagnosed with cancer during the stroke hospitalization, and 78% of the SAC patients were without metastasis. Conclusions The most frequent aetiologies of stroke in cancer patients were cryptogenic stroke, followed by large-artery atherosclerosis. SAC patients had more severe neurological deficits and worse clinical outcomes than SWC patients. Stroke in cancer patients appears to be more frequently cryptogenic, probably due to cancer associated thrombosis. The association between stroke and cancer is important, especially in stroke of cryptogenic mechanism, even in the presence of traditional cardiovascular risk factors.

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

“…AIS is the second most common complication that involves the central nervous system in cancer patients, the first being cerebral metastases. 17 Viewed another way, one-in-ten patients with AIS have a history of remote or active cancer, making it critical to establish the best management strategies for LVO in this vulnerable group of patients. 18 In an autopsy study, it was reported that almost 15% of cancer patients had a stroke on post-mortem examination, with hemorrhagic and ischemic strokes being equally prevalent.…”

“…20 In a recent retrospective cross-sectional study, the most common stroke mechanism in cancer patients was cryptogenic (embolic stroke of unknown source), followed by large vessel disease. 17,21 Conventional stroke risk factors such as hypertension, diabetes, and atrial fibrillation are underrepresented in cancer-related stroke, invoking hypercoagulability and other cancer-specific causes of stroke. 10,22,23 Stroke patients with cancer are often excluded from receiving thrombolytic therapy due to concerns about brain metastasis, thrombocytopenia, coagulopathy, recent surgery, or overall poor prognosis.…”

“…AIS is the second most common complication that involves the central nervous system in cancer patients, the first being cerebral metastases [ 17 ]. Viewed another way, one-in-ten patients with AIS have a history of remote or active cancer, making it critical to establish the best management strategies for LVO in this vulnerable group of patients [ 18 ].…”

“…Hypercoagulability in patients with cancer is hypothesized to be due to tumor cell-derived cytokines, elevated D-dimer levels, tumor embolism, chemotherapy, as well as vascular risk factors like diabetes and hypertension [ 9 , 10 , 19 ], and it is believed that embolism secondary to hypercoagulability is the most important cause of stroke in cancer patients [ 20 ]. In a recent retrospective cross-sectional study, the most common stroke mechanism in cancer patients was cryptogenic (embolic stroke of unknown source), followed by large vessel disease [ 17 , 21 ]. Conventional stroke risk factors such as hypertension, diabetes, and atrial fibrillation are underrepresented in cancer-related stroke, invoking hypercoagulability and other cancer-specific causes of stroke [ 10 , 22 , 23 ].…”

Cancer and stroke: commonly encountered by clinicians, but little evidence to guide clinical approach

“… 9 Studies investigating TOAST (Trial of Org 10172 in Acute Stroke Treatment) subtypes among patients with ischemic stroke and concomitant cancer reported cryogenic stroke to be the most frequent subtype. 14 , 17 , 18 Furthermore, Cestari et al 19 reported embolic ischemic stroke to be more common than non-embolic in ischemic stroke patients with underlying cancer, comprising 54% compared with 46%.…”