Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy

Abstract

Endovascular thrombectomy (EVT) is the preferred treatment strategy for patients with acute ischemic stroke (AIS). However, clinical outcome and prognosis in patients who undergo EVT in response to AIS with concomitant malignancy have not been fully elucidated. Data of patients with malignancy who underwent EVT at participating institutions between January 2015 and April 2019 were retrospectively analyzed. Patient characteristics, treatment methods, posttreatment strategy, and long-term prognosis were evaluated in 12 patients with prediagnoses of malignancy. Good revascularization (TICI 2b or higher) was achieved in 10 of 12 patients. Among the eight patients who survived more than 2 weeks from onset, four patients showed good clinical outcome [modified Rankin Scale (mRS) <2] at 60 days posttreatment and were able to continue treatment for malignancy. However, seven of eight patients died within a year of EVT (median survival, 83 days) due to progression of malignancy. One-year survival was achieved in only one patient whose etiology of stroke was determined as infectious endocarditis and not Trousseau syndrome. Even after successful revascularization and good short-term clinical outcome, the long-term prognosis after thrombectomy in patients with malignancy was poor. Thrombectomy for concomitant malignancy requires judicious decision, and further studies are necessary to fully elucidate its efficacy.

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

“…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 ].…”

“…There was a certain amount of discrepancy regarding the patients included in the studies. Most studies included patients with AIS and an active malignancy (AM), defined as patients with a diagnosis of current or metastatic cancer, those undergoing treatment for cancer, or who refused the treatment [ 6 , 7 , 10 , 11 , 13 , 14 , 15 , 16 , 18 , 24 ], and at times patients with a diagnosis made during or after the AIS-hospitalization [ 10 , 14 , 15 ]. This definition was occasionally restricted to a diagnosis within a year or 6months, or cancer treatment within 1–6 months of the ischemic event [ 7 , 11 , 18 , 23 ].…”

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

“…Further, stroke affects mortality in patients with active cancer by various ways including the termination of malignancy treatment and the worsening of general conditions. Moreover, Oki et al showed that 92% of patients with cancer-related stroke died within 1 y after the stroke occurred [ 17 ]. In cancer patients, thromboembolism and progression of cancer are major causes of death.…”

“…Lee et al [12] Jung et al [13] Cho et al [14] Sallustio et al [15] Jeon et al [16] Oki et al [17] Present report cases in which MT cannot be performed in consideration of risks and benefits. However, this study lacks consideration for these cases, including only the cases where MT was performed.…”

“…Therefore, mechanical thrombectomy (MT) for occluded large vessels can be a particularly important treatment option for CRS patients [10,11]. However, although there have been earlier studies showing the overall outcomes of MT in patients with CRS [12][13][14][15][16][17], the effectiveness of MT on CRS remains controversial as patients with active cancer were excluded from previous important clinical trials [18][19][20][21]. To the best of our knowledge, there have not been any studies investigating the independent factors associated with the functional outcomes of CRS after MT.…”