Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke

Abstract

Background and aimIdentification of paraneoplastic hypercoagulability in stroke patients helps to guide investigations and prevent stroke recurrence. A previous study demonstrated an association between the absence of the susceptibility vessel sign (SVS) on brain MRI and active cancer in patients treated with mechanical thrombectomy. The present study aimed to confirm this finding and assess an association between the absence of the hyperdense vessel sign (HVS) on head CT and active cancer in all stroke patients.MethodsSVS and HVS status on baseline imaging were retrospectively assessed in all consecutive stroke patients treated at a comprehensive stroke center between 2015 and 2020. Active cancer, known at the time of stroke or diagnosed within 1 year after stroke (occult cancer), was identified. Adjusted odds ratios (aOR) and their 95% confidence interval (CI) for the association between the thrombus imaging characteristics and cancer were calculated using multivariable logistic regression.ResultsOf the 2,256 patients with thrombus imaging characteristics available at baseline, 161 had an active cancer (7.1%), of which 36 were occult at the time of index stroke (1.6% of the total). The absence of SVS was associated with active cancer (aOR 3.14, 95% CI 1.45–6.80). No significance was reached for the subgroup of occult cancer (aOR 3.20, 95% CI 0.73–13.94). No association was found between the absence of HVS and active cancer (aOR 1.07, 95% CI 0.54–2.11).ConclusionThe absence of SVS but not HVS could help to identify paraneoplastic hypercoagulability in stroke patients with active cancer and guide patient care.

Cancer-Associated Stroke and Acute Endovascular Reperfusion Therapy

“…[40][41][42] As mentioned earlier, retrieved thrombi from cases with stroke caused by cancerrelated hypercoagulability exhibit minimal erythrocyte components, as evidenced by Jung et al's study, 26) where all 19 cases of cancer-related cryptogenic stroke showed absence of SVS. Beyeler et al 43) also showed a significant association between absence of SVS and active cancer (aOR, 3.14; 95% CI, 1.45-6.80) from a large thrombectomy cohort analysis including a total of 2256 cases. Additionally, platelet-rich thrombi have been reported to show isoattenuation (Hounsfield Unit value <50) on non-contrast CT. 44) The absence of HVS/SVS findings might, thus, suggest the presence of stroke caused by cancer-related hypercoagulability in patients with cancer-associated stroke.…”

Foam Cells Analysis from Retrieved Stroke Clot for the Identification of Atherothrombotic Etiology

“…Histological thrombus composition in LVO may represent an interesting research question, as it is an important feature that may help to specify stroke pathogenesis, differentiating between cardioembolic and atherothrombotic stroke causes. Further clinical and radiological factors predicting stroke etiology might support histological findings, i.e., considering the systematic assessment of hyperdense vessel signs in native computed tomography and/or susceptibility vessel signs in susceptibility-weighted imaging on brain magnetic resonance imaging [39]. Our study showed the presence of FCs in approximately one-third of the retrieved clots, but the identification of the clot that presumably comes from the atheromatous plaque rupture tended to disagree with the clinical diagnosis, even if the difference between FC and NFC groups did not reach the statistical significance.…”