Distinction in Prevalence of Atherosclerotic Embolic Sources in Cryptogenic Stroke With Cancer Status

Abstract

Background Cerebrovascular diseases are common comorbidities in patients with cancer. Although active cancer causes ischemic stroke by multiple pathological conditions, including thromboembolism attributable to Trousseau syndrome, the relationship between stroke and inactive cancer is poorly known. The aim of this study was to elucidate the different underlying pathogeneses of cryptogenic stroke in active and inactive patients with cancer, with detailed investigation by transesophageal echocardiography. Methods and Results CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for Embolic Stroke of Undetermined Source/Cryptogenic Stroke) registry is a multicenter registry including data of patients initially diagnosed as having cryptogenic stroke and undergoing transesophageal echocardiography. Patients were divided into active cancer, inactive cancer, and noncancer groups, and their clinical features were compared. Of the total 667 enrolled patients (age, 68.7±12.8 years; 455 men), 41 (6.1%) had active cancer, and 51 (7.5%) had a history of inactive cancer. On multinomial logistic regression analysis, infarctions in multiple vascular territories (odds ratio [OR], 2.73; 95% CI, 1.39–5.40) and CRP (C‐reactive protein) (OR, 1.10; 95% CI, 1.01–1.19) were independently associated with active cancer, whereas age (OR, 1.05; 95% CI, 1.01–1.08), contralateral carotid stenosis from the index stroke lesion (OR, 4.05; 95% CI, 1.60–10.27), calcification of the aortic valve (OR, 2.10; 95% CI, 1.09–4.05), and complicated lesion of the aortic arch (OR, 2.13; 95% CI, 1.11–4.10) were significantly associated with inactive cancer. Conclusions Patients with cancer were not rare in cryptogenic stroke. Although patients with active cancer had more multiple infarctions, patients with inactive cancer had more atherosclerotic embolic sources potentially causing arteriogenic strokes. Registration URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN000032957.

Cryptogenic stroke. Part 4: Antiphospholipid syndrome and cancer

“…По данным регистра CHALLENGE ESUS/CS (пациенты с криптогенным инсультом и ЧП-ЭхоКГ), активное ЗНО выявлено в 6,1% случаев, неактивный рак -в 7,5% случаев. Активный рак оказался ассоциирован с множественными инфарктами, тогда как неактивный -с наличием атеросклеротических источников эмболии [68].…”

Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer

“… 17 Thus, many studies sought to identify the typical characteristics of cancer-associated, presumably paraneoplastic stroke in comparison to ischemic stroke not associated with cancer. These characteristics have been found to comprise the simultaneous involvement of two or more vascular territories, 18 – 20 elevated lactate dehydrogenase (LDH), 6 elevated D-dimers as marker for hypercoagulability, 19 – 22 as well as a systemic inflammatory response with increased C-reactive protein (CRP) 18 , 22 – 24 and relative granulocytosis. 6 , 20 All these laboratory markers are also elevated in cancer patients compared to controls; 25 , 26 however, CRP and D-dimer elevations are more pronounced in patients with cancer and concomitant ischemic stroke compared to patients with cancer only.…”

Identification of a 6-RBP gene signature for a comprehensive analysis of glioma and ischemic stroke: Cognitive impairment and aging-related hypoxic stress

“…A postmortem-based study reported that about 14.6% of non-CNS cancer cases showed cerebrovascular disease (CVD) (Graus et al, 1985 ). Moreover, embolic strokes are the most common cause of strokes in patients with cancer, possibly due to intravascular coagulopathy (Cestari et al, 2004 ); patients with active cancer show multiple infarcts (Kikuno et al, 2021 ). Gliomas account for 60% of ischemic strokes secondary to primary brain tumors, whereby complications due to surgery and radiotherapy form the majority (Kreisl et al, 2008 ).…”

“…A postmortem-based study reported that about 14.6% of non-CNS cancer cases showed cerebrovascular disease (CVD) (Graus et al, 1985). Moreover, embolic strokes are the most common cause of strokes in patients with cancer, possibly due to intravascular coagulopathy (Cestari et al, 2004); patients with active cancer show multiple infarcts (Kikuno et al, 2021). Gliomas account Abbreviations: TCGA, The cancer genome atlas; CGGA, Chinese glioma genome atlas; LGG, Lower-grade gliomas; GBM, Glioblastomas; RBP, RNA-binding protein; LASSO, Least absolute shrinkage and selection operator; GO, Gene ontology; GSEA, Gene set enrichment analysis; IDH, Isocitrate dehydrogenases; MGMT, O -methylguanine-DNA methyltransferase; IS, Ischemic stroke.…”