Recanalisation theraphy for acute ischemic stroke in cancer patients

Abstract

To date, very few studies focused their attention on efficacy and safety of recanalisation therapy in acute ischemic stroke (AIS) patients with cancer, reporting conflicting results. We retrospectively analysed data from our database of consecutive patients admitted to the Udine University Hospital with AIS that were treated with recanalisation therapy, i.e. intravenous thrombolysis (IVT), mechanical thrombectomy (MT), and bridging therapy, from January 2015 to December 2019. We compared 3-month dependency, 3-month mortality, and symptomatic intracranial haemorrhage (SICH) occurrence of patients with active cancer (AC) and remote cancer (RC) with that of patients without cancer (WC) undergoing recanalisation therapy for AIS. Patients were followed up for 3 months. Among the 613 AIS patients included in the study, 79 patients (12.9%) had either AC (n = 46; 7.5%) or RC (n = 33; 5.4%). Although AC patients, when treated with IVT, had a significantly increased risk of 3-month mortality [odds ratio (OR) 6.97, 95% confidence interval (CI) 2.42–20.07, p = 0.001] than WC patients, stroke-related deaths did not differ between AC and WC patients (30% vs. 28.8%, p = 0.939). There were no significant differences between AC and WC patients, when treated with MT ± IVT, regarding 3-month dependency, 3-month mortality and SICH. Functional independence, mortality, and SICH were similar between RC and WC patients. In conclusion, recanalisation therapy might be used in AIS patients with nonmetastatic AC and with RC. Further studies are needed to explore the outcome of AIS patients with metastatic cancer undergoing recanalisation therapy.

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 ].…”

“…Others utilized ICD codes pertaining to active and metastatic malignancies [ 20 , 21 , 22 ], while certain studies analyzed all patients with any history of cancer [ 9 ], or did not provide a solid definition of active/underlying cancer [ 17 ]. Entities such as myelodysplastic syndromes and non-invasive basal cell carcinoma were, in certain studies, specifically mentioned as not considered within the definition of active cancer [ 23 ], while others excluded patients with hematological or intracranial malignancies/metastases [ 14 , 15 , 21 ]. Intracranial tumors are usually considered a contraindication for recanalization procedures [ 5 ], and, as such, these patients might have been excluded in the majority of studies without specific mention.…”

“…Cancer patients were also more often found to have increased pre-stroke disability (modified Rankin Scale-mRS score ≥2) [ 23 ]. A few studies compared baseline values of biochemical markers commonly associated with cancer and cancer-related stroke [ 2 ], and found higher mean CRP [ 13 , 14 ] and D-dimer values [ 18 ], higher leukocyte counts [ 14 ], lower hemoglobin [ 14 , 18 ], and lower platelet counts [ 14 , 15 ]. Higher D-dimer values also correlated with unfavorable outcomes [ 14 ].…”

“…In-hospital mortality (IHM) was assessed in 11 studies ( Table 3 , 3 CRS studies, see Section 3.6 ). Three studies found IHM significantly increased in active CPs compared to NCPs [ 11 , 22 , 23 ], and three studies found the difference between CPs and NCPs not statistically significant [ 10 , 17 ], with one of them reporting no difference in IHM between patients with active cancer, remote cancer, and no cancer history [ 15 ]. This was also shown in a study on IVT, which reported that in the subgroup of IVT+MT, IHM was not different between CP and NCP groups [ 20 ].…”