Advancements in the Treatment of Cerebrovascular Complications of Cancer

Richter

James

et al. 2022

JCM

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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.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Richter

James

et al. 2022

JCM

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“… 18 However, as many studies and a subsequent meta-analysis have so far demonstrated, IVT appears to be similar in terms of safety (symptomatic intracranial hemorrhage: OR 2.12, 95% CI = 0.33–13.76; in-hospital mortality: OR 1.30, 95% CI = 0.93–1.81; and 3-month mortality: OR 1.00, 95% CI = 0.49–2.03) and efficacy (functional independence, expressed a modified Rankin Scale scores 0–2: OR 1.00, 95% CI = 0.51–1.97) in patients with and without cancer. 24 , 25 As such, cancer per se is no contraindication for IVT, 26 and cancer patients should be assessed for IVT based on the existing eligibility criteria. 21 , 27 In terms of guidelines, specific mentions of cancer have only so far emerged in the American Heart Association Guidelines, 21 where IVT can be considered in cancer patients with a reasonable life expectancy, with gastrointestinal (GI) and intra-axial brain neoplasms being named as contraindications.…”

Section: Acute Managementmentioning

confidence: 99%

Acute reperfusion treatment and secondary prevention of cancer-related stroke: comprehensive overview and proposal of clinical algorithm

Palaiodimou

et al. 2023

Ther Adv Neurol Disord

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Cancer-related stroke (CRS), referring to ischemic stroke occurring in cancer patients without other clear etiology, represents a clinical challenge, as it is associated with unfavorable clinical outcomes including high rates of recurrence and mortality. There are scarce international recommendations and limited consensus statements on CRS management. For this comprehensive overview, the available studies/reviews/meta-analyses on the use of acute reperfusion and secondary prevention treatments for cancer patients with ischemic stroke, focusing on antithrombotic agents, were collected and summarized. A practical management algorithm was designed per the available data. In short, acute reperfusion in the form of intravenous thrombolysis and mechanical thrombectomy appears to be safe in CRS and can be considered for eligible patients, though the functional outcomes are often poor, and mostly defined by the preexisting condition. Many patients carry indications for anticoagulation, in which case vitamin K antagonists are not preferred, while low-molecular weight heparins remain the treatment of choice; direct oral anticoagulants can be alternatively considered but are contraindicated for gastrointestinal malignancies. For patients without clear anticoagulation indications, no net benefit for anticoagulation compared to aspirin has been shown. Other targeted treatment options should be evaluated in an individualized approach, alongside the appropriate management of conventional cerebrovascular risk factors. Oncological treatment should be swiftly initiated/continued. In conclusion, acute CRS remains a clinical challenge, with many patients suffering recurrent stroke, despite preventive measures. More randomized-controlled clinical trials are urgently needed to pinpoint the most effective management options for this subset of stroke patients.

“…This region is called the 'penumbra' and its salvation is, in principle, the target of all therapeutic interventions [3]. The main treatment options in IS are intravenous alteplase/recombinant tissue plasminogen activator (rTPA) and endovascular thrombectomy [4], but even when these are applied in a timely manner, many individuals do not regain their functional status [3]. One of the hypothesized causes is the perfusion failure of the microvasculature downstream of the occluded vessel, which leads to a progressive increase in infarct volume [5].…”

Section: Introductionmentioning

confidence: 99%

Thinking Outside the Ischemia Box: Advancements in the Use of Multiple Sclerosis Drugs in Ischemic Stroke

Siokas

Pateraki

et al. 2021

JCM

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Ischemic stroke (IS) is a major cause of death and disability, despite early intervention. Thrombo-inflammation, the inflammatory process triggered by ischemia, is a concept that ties IS with multiple sclerosis (MS), under the wider ‘umbrella’ of neuroinflammation, i.e., the inflammation of the nervous tissue. Drawing from this, numerous studies have explored the potential of MS disease-modifying drugs in the setting of IS. In this review, we present the available studies and discuss their potential in ameliorating IS outcomes. Based on our search, the vast majority of the studies have been conducted on animals, yielding mostly positive results. Two clinical trials involving natalizumab showed that it does not confer any benefits, but four human studies regarding fingolimod have showcased its potential in improving recovery prospects. However, concerns on safety and other issues are raised, and basic questions still need to be answered.