Utilization rates of tissue plasminogen activator and mechanical thrombectomy in patients with acute stroke and underlying malignancy

Rinaldo, Lorenzo; Cloft, Harry J.; Castilla, Leonardo Rangel; Rabinstein, Alejandro A.; Brinjikji, Waleed

doi:10.1136/neurintsurg-2018-014480

Cited by 14 publications

(20 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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 ].…”

Section: Resultsmentioning

confidence: 99%

“…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 ].…”

Section: Resultsmentioning

confidence: 99%

“…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 ].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Aloizou

Richter

James

et al. 2022

JCM

View full text Add to dashboard Cite

Background: Ischemic stroke is a common occurrence in patients with concomitant malignancy. Systemic thrombolysis is often contraindicated in these patients, and mechanical thrombectomy (MT) is the preferred method of intervention. This review aims to collect the available data on the safety and efficacy of MT in cancer patients (CPs).Methods: The PubMed/MEDLINE and SCOPUS databases were systematically searched for studies assessing safety (mortality, intracranial hemorrhage) and efficacy (reperfusion, functional outcome) indices in CPs receiving MT. Potentially relevant parameters examined in solitary studies were also extracted (e.g., stroke recurrence, brain malignancy).Results: A total of 18 retrospective studies of various methodologies and objectives were identified. Rates of in-hospital mortality, intracranial hemorrhage of any kind, reperfusion rates, and discharge condition did not seem to present any considerable differences between CPs and patients without cancer. On the contrary, 90-day mortality was higher and 90-day functional independence was lower in CPs. Three studies on cancer-related stroke (no other identifiable etiology and high D-dimer levels in the presence of active cancer) showed constant tendencies towards unfavorable conditions. Conclusions: Per the available evidence, MT appears to be a safe treatment option for CPs. It is still unclear whether the 90-day mortality and outcome rates are more heavily influenced by the malignancy and not the intervention itself, so MT can be considered in CPs with prospects of a good functional recovery, undertaking an individualized approach.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Aloizou

Richter

James

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…There has been a growing number of acute ischemic stroke patients with active cancer due to advances in cancer treatment and the expanding aging population. About 5% of hospitalized ischemic stroke patients have comorbid cancer; among them, 3.1% have LVO treated by EVT ( 2 ). Ischemic stroke associated with active cancer has different behaviors due to the specific etiologic mechanism and outcomes.…”

Section: Introductionmentioning

confidence: 99%

Significance of D-Dimer in Acute Ischemic Stroke Patients With Large Vessel Occlusion Accompanied by Active Cancer

et al. 2022

View full text Add to dashboard Cite

BackgroundThis study aimed to investigate clinical outcome predictors of acute stroke patients with large vessel occlusion and active cancer and validate the significance of D-dimer levels for endovascular thrombectomy decisions.MethodsWe analyzed a prospectively collected hospital-based stroke registry to determine clinical EVT outcomes of acute stroke patients within 24 h with following criteria: age ≥18 years, NIHSS ≥6, and internal carotid artery or middle cerebral artery lesion. All patients were classified into EVT and non-EVT groups. Patients were divided into two groups by initial D-dimer level. We explored variables potentially associated with successful recanalization as well as 3-month functional outcomes and mortality rates.ResultsAmong 68 patients, 36 were treated with EVT, with successful recanalization in 55.6%. The low D-dimer group showed a higher rate of successful recanalization and favorable outcome than the high D-dimer group. The mortality rate was higher in the high D-dimer group. No EVT and high D-dimer level were independent predictors of mortality, whereas lesion volume and low D-dimer level were independently associated with favorable outcomes.ConclusionsD-dimer level is a prognostic factor in acute LVO stroke patients with active cancer, and its high value for EVT decisions provisionally supports its testing in this patient population.

show abstract

“…About 5% of hospitalized ischemic stroke patients have comorbid cancer; among them, 3.1% have LVO treated by EVT. 2 Ischemic stroke associated with active cancer has different behaviors due to the speci c etiologic mechanism and outcomes. Stroke patients with active cancer usually have poorer outcomes, have high mortality rates, and are at a higher risk of bleeding complications than non-cancer stroke patients.…”

Section: Introductionmentioning

confidence: 99%

Title: Significance of D-dimer in acute ischemic stroke patients with large vessel occlusion accompanied by active cancer

Pan

Kim

Chung

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: This study aimed to investigate clinical outcome predictors of acute stroke patients with large vessel occlusion and active cancer and validate the significance of d-dimer levels for endovascular thrombectomy decisions.Methods: We analyzed a prospectively collected hospital-based stroke registry to determine clinical EVT outcomes of acute stroke patients within 24 hours with following criteria: age≥18 years, NIHSS≥6, and internal carotid artery or middle cerebral artery lesion. All patients were classified into EVT and non-EVT groups. Patients were divided into two groups by initial d-dimer level. We explored variables potentially associated with successful recanalization as well as 3-month functional outcomes and mortality rates. Results: Among 68 patients, 36 were treated with EVT, with successful recanalization in 55.6%. The low d-dimer group showed a higher rate of successful recanalization and favorable outcome than the high d-dimer group. The mortality rate was higher in the high d-dimer group. EVT and high d-dimer level were independent predictors of mortality, whereas lesion volume and low d-dimer level were independently associated with favorable outcomes.Conclusions: d-dimer level is a prognostic factor in acute LVO stroke patients with active cancer, and its high value for EVT decisions provisionally supports its testing in this patient population.

show abstract

Utilization rates of tissue plasminogen activator and mechanical thrombectomy in patients with acute stroke and underlying malignancy

Cited by 14 publications

References 13 publications

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

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

Significance of D-Dimer in Acute Ischemic Stroke Patients With Large Vessel Occlusion Accompanied by Active Cancer

Title: Significance of D-dimer in acute ischemic stroke patients with large vessel occlusion accompanied by active cancer

Contact Info

Product

Resources

About