Cancer‐related stroke: Exploring personalized therapy strategies

Abstract

Background: Cancer and ischemic stroke are two common diseases that threaten human health and have become the main causes of death in the world. It is estimated that one-in-ten patients with ischemic stroke have concomitant cancer, and this incidence is expected to increase as improvements in medical technology extends the life expectancy of cancer patients.Discussion: Cancer-related stroke (CRS) refers to unexplained ischemic stroke in patients with active cancer that cannot be explained by current stroke mechanisms.Available evidence suggests that CRS accounts for 5-10% of embolic stroke of undetermined source (ESUS). Although the incidence of CRS is gradually increasing, its underlying pathogenesis remains unclear. Also, there is no consensus on acute treatment and secondary prevention of stroke. Conclusion:In this review, we retrospectively analyzed the incidence, mechanisms of CRS, its potential as a new stroke subtype, options for acute treatment, secondary prevention strategies, and disease progression, with the aim of attempting to explore personalized therapy strategies.

Recurrent Strokes in a Patient With Metastatic Lung Cancer

“…While there is evidence of the benefit of thrombolysis, bleeding is almost inevitable. Different hospitals follow different protocols, but mechanical thrombectomy is considered first-line treatment where possible, like in anterior large vessel stroke [10]. Drugs like aspirin and rivaroxaban have also been studied and routinely used in the management of such patients.…”

Extracellular Vesicles as Delivery Shippers for Noncoding RNA‐Based Modulation of Angiogenesis: Insights from Ischemic Stroke and Cancer

“…Cancer is an incurable and lethal disease and the second leading cause of death and disability globally following ischemic stroke. [32,33] Evidence from extensive epidemiological data shows that ≈16.9 million people suffer a stroke yearly, representing a global incidence of 258/1 000 000/year. [34] Tens of millions of people are diagnosed with cancer around the globe, and nearly 10 million of the patients ultimately die from it.…”

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

“…67 For cancer-associated NBTE, a surgical treatment may be considered only in selected patients who do not respond to anticoagulation. 5,68 Continuation of oncological treatment Contact with the treating oncologist should be initiated soon after admitting the patient to establish common goals of care and carefully assess the patient's medication since many chemotherapy agents predispose toward IS 2 and should be discontinued, while they may also interact with medications under consideration for the patient. Finally, all these antithrombotic approaches can be seen as 'futile' when the underlying pathology, that is, the cancer, remains untreated.…”

“…This term usually pertains to an IS that arises as a direct result of the malignancy itself, mainly due to cancer-induced hypercoagulability. 5 In most studies, it is defined as an IS in patients with a known malignancy, proof of hypercoagulability usually in the form of elevated D-dimers, ischemic lesions in multiple vascular territories in the magnetic resonance imaging (MRI), and no evidence of other ‘conventional’ stroke mechanisms; 6 these factors have all been repeatedly associated with ‘cryptogenic’ strokes in cancer patients. 7 Consequently, these strokes mostly fall into the ‘unknown/cryptogenic origin’ TOAST (Trial of Org 10172 in Acute Stroke Treatment) category 8 and are often described as ‘embolic stroke of unknown source’ (ESUS).…”

“… 7 Consequently, these strokes mostly fall into the ‘unknown/cryptogenic origin’ TOAST (Trial of Org 10172 in Acute Stroke Treatment) category 8 and are often described as ‘embolic stroke of unknown source’ (ESUS). It has also been suggested that stroke in cancer patients could eventually represent a separate category of IS 5 , 9 since CRS represents a classification challenge. It may be at times referred to as ‘other determined etiology’ when the underlying hypercoagulability/Trousseau’s syndrome has been diagnosed, or even hide behind a ‘cardioembolic’ classification, for instance in cases of non-bacterial thrombotic endocarditis (NBTE), which is often detected in cancer patients and also falls into the cancer-associated hypercoagulability spectrum.…”