Absence of Susceptibility Vessel Sign in Patients With Malignancy-Related Acute Ischemic Stroke Treated With Mechanical Thrombectomy

Beyeler, Morin; Belachew, Nebiyat Filate; Kielkopf, Moritz; Aleman, Enrique Barvulsky; Betancourt, Alejandro Xavier León; Genceviciute, Kotryna; Kurmann, Christoph; Grunder, Lorenz; Birner, Barbara; Meinel, Thomas; Scutelnic, Adrian; Bücke, Philipp; Seiffge, David J; Dobrocky, Tomas; Piechowiak, Eike Immo; Pilgram‐Pastor, Sara; Mattle, Heinrich; Mordasini, Pasquale; Arnold, Marcel; Fischer, Urs; Pabst, Thomas; Gralla, Jan; Berger, Martin D.; Jung, Simon; Kaesmacher, Johannes

doi:10.3389/fneur.2022.930635

Cited by 8 publications

(5 citation statements)

References 42 publications

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“…The use of oral anticoagulants seems more appropriate but major guidelines currently advocate for randomized trials ( 32 , 33 ). According to previous evidence, the absence of SVS demonstrated the strongest association with active cancer in multivariable analysis ( Figure 2 ) ( 14 ). Even if the auROC of the model with SVS tended to be greater, no statistical difference was found ( Figure 3A ).…”

Section: Discussionsupporting

confidence: 66%

“…Newly diagnosed cancer within one year after the index stroke was defined as “occult cancer” at the time of stroke and considered an active cancer for the purposes of this study ( 4 , 20 , 21 ). As defined previously, patients with focal non-melanoma skin cancer and those treated with prophylactic hormone therapy for prior breast cancer were classified as not having active cancer ( 14 , 22 , 23 ).…”

Section: Methodsmentioning

confidence: 99%

“…The composition of intracranial thrombi can be assessed non-invasively and in situ with thrombus imaging characterization as a surrogate marker ( 13 ). Our previous study demonstrated an association between the absence of the susceptibility vessel sign (SVS) in susceptibility-weighted imaging (SWI) on brain magnetic resonance imaging (MRI) and active cancer in patients treated with mechanical thrombectomy ( 14 ). The reason for the absence of SVS with active cancer may be due to a predominance of fibrin and platelets and a relative paucity of erythrocytes in these patients thrombus composition ( 11 , 12 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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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.

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Section: Discussionsupporting

confidence: 66%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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“…Known cancer was considered active when being newly diagnosed, recurrent, or treated within 6 months before the index TIA, or in case of metastatic spread (according to information obtained from our clinic information system) ( 12 , 13 ). The limit of 12 months after TIA for the identification of occult cancer at the time of TIA was based on previous evidence ( 3 , 14 , 15 ). Occult cancer cases were either retrospectively identified in our clinic information system or documented in follow-up consultations.…”

Section: Methodsmentioning

confidence: 99%

Transient ischemic attacks in patients with active and occult cancer

Beyeler,

Castigliego,

Baumann

et al. 2023

Front. Neurol.

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Background and aimParaneoplastic coagulopathy can present as stroke and is associated with specific biomarker changes. Identifying paraneoplastic coagulopathy can help guide secondary prevention in stroke patients, and early cancer detection might improve outcomes. However, unlike ischemic stroke, it remains unclear whether paraneoplastic coagulopathy is associated with transient ischemic attacks (TIA). This study assessed the presence of cancer-related biomarkers in TIA patients and evaluated long-term mortality rates in patients with and without active cancer.MethodsActive cancer was retrospectively identified in consecutive TIA patients treated at a comprehensive stroke center between 2015 and 2019. An association between the presence of cancer and cancer-related biomarkers was assessed using multivariable logistic regression. Long-term mortality after TIA was analyzed using multivariable Cox regression.ResultsAmong 1436 TIA patients, 72 had active cancer (5%), of which 17 were occult (1.2%). Cancer-related TIA was associated with male gender (adjusted odds ratio [aOR] 2.29, 95% CI 1.12–4.68), history of smoking (aOR 2.77, 95% CI 1.34–5.7), elevated D-dimer (aOR 1.77, 95% CI 1.26–2.49), lactate dehydrogenase (aOR 1.003, 95% CI 1.00–1.005), lower leukocyte count (aOR 1.20, 95% CI 1.04–1.38), and lower hemoglobin (aOR 1.02, 95% CI 1.00–1.04). Long-term mortality was associated with both active cancer (adjusted hazard ratios [aHR] 2.47, 95% CI 1.58–3.88) and occult cancer (aHR 3.08, 95% CI 1.30–7.32).ConclusionCancer-related TIA is not uncommon. Biomarkers known to be associated with cancer-related stroke also seem to be present in TIA patients. Early identification would enable targeted treatment strategies and could improve outcomes in this patient population.

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“…However, a recent study by Beyeler et al on 40 AIS patients with cancer found that the absence of SVS was associated with having a cancer but could not predict occult cancer better than clinical predictors. 100 A more refined SVS analysis using quantitative susceptibility mapping may increase the predictive power of this model. 101 As described previously (see "Stroke Mechanisms in Cancer Patients"), NBTE is another possible mechanism of cancer-related stroke linked to hypercoagulability.…”

Section: Magnetic Resonance Imaging and Transcranial Dopplermentioning

confidence: 99%

Ischemic Stroke in Cancer: Mechanisms, Biomarkers, and Implications for Treatment

Costamagna

Navi

Beyeler

et al. 2023

Semin Thromb Hemost

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Ischemic stroke is an important cause of morbidity and mortality in cancer patients. The underlying mechanisms linking cancer and stroke are not completely understood. Long-standing and more recent evidence suggests that cancer-associated prothrombotic states, along with treatment-related vascular toxicity, such as with chemotherapy and immunotherapy, contribute to an increased risk of ischemic stroke in cancer patients. Novel biomarkers, including coagulation, platelet and endothelial markers, cell-free DNA, and extracellular vesicles are being investigated for their potential to improve risk stratification and patient selection for clinical trials and to help guide personalized antithrombotic strategies. Treatment of cancer-related stroke poses unique challenges, including the need to balance the risk of recurrent stroke and other thromboembolic events with that of bleeding associated with antithrombotic therapy. In addition, how and when to restart cancer treatment after stroke remains unclear. In this review, we summarize current knowledge on the mechanisms underlying ischemic stroke in cancer, propose an etiological classification system unique to cancer-related stroke to help guide patient characterization, provide an overview of promising biomarkers and their clinical utility, and discuss the current state of evidence-based management strategies for cancer-related stroke. Ultimately, a personalized approach to stroke prevention and treatment is required in cancer patients, considering both the underlying cancer biology and the individual patient's risk profile.

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Absence of Susceptibility Vessel Sign in Patients With Malignancy-Related Acute Ischemic Stroke Treated With Mechanical Thrombectomy

Cited by 8 publications

References 42 publications

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

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

Transient ischemic attacks in patients with active and occult cancer

Ischemic Stroke in Cancer: Mechanisms, Biomarkers, and Implications for Treatment

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