Endovascular Therapy is Effective for Large Vessel Occlusion Despite Concurrent Cancer

Mattingly, Thomas; Risco, Jorge E; Burch, Jaclyn E; Whyte, Raquel; Kohli, G; Susa, Stephen; Bhalla, Tarun; Bender, Matthew T.

doi:10.1016/j.jstrokecerebrovasdis.2022.106439

Cited by 8 publications

(19 citation statements)

References 29 publications

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“…All of the included studies were retrospective analyses of either files/databases of patients that received acute treatment for AIS [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], or analyses of hospital records with the use of diagnostic codes, e.g., ICD codes for AIS and malignancy [ 20 , 21 , 22 ]. One study was a retrospective analysis of cancer patients from the MR CLEAN thrombectomy study registry [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Higher D-dimer values also correlated with unfavorable outcomes [ 14 ]. Respiratory, genitourinary, pancreatic, colorectal, and breast cancers were the most common cancer types reported [ 6 , 17 , 18 , 21 , 23 ], with adenocarcinomas also being mentioned as the most prevalent histological cancer type [ 7 , 8 ].…”

Section: Resultsmentioning

confidence: 99%

“…The 90-day mortality (90DM) was assessed in 14 studies ( Table 3 , 3 CRS studies, see Section 3.6 ) and was often found significantly increased in active CPs compared to NCPs [ 8 , 9 , 10 , 11 , 13 , 23 ]. In one study assessing long-term prognosis, 7 of 12 (58.3%) CPs deceased by the 90-day time-point, and 11 of 12 (91.6%) CPs treated with MT deceased due to stroke- or malignancy-related reasons within a year [ 7 ].…”

Section: Resultsmentioning

confidence: 99%

“…SICH was most commonly defined as a neurological worsening in terms of an increase in NIHSS (National Institutes of Health Stroke Scale) scores of ≥4, with radiological evidence of an ICH [ 17 , 23 ], though a definition was not always provided [ 16 ]. One study reported adherence to the Safe Implementation of Treatments in Stroke (SITS) criteria, defining sICH as a Type 2 parenchymal hemorrhage with clinical deterioration in NIHSS score of ≥4, or death [ 10 ], and six used the European–Australasian Cooperative Acute Stroke Study III Criteria, defining sICH as any extravasated blood in the parenchyma or within the cranium, that was the predominant cause of neurological deterioration in NIHSS score of ≥4, or death [ 8 , 11 , 15 , 17 , 18 , 19 ]. Most included studies reported no statistically significant differences in sICH between CPs and NCPs (one study assessed sICH only within 24 h [ 16 ]) [ 10 , 11 , 16 , 17 , 18 , 23 ], despite an occasional tendency towards increased rates in CPs [ 11 ].…”

Section: Resultsmentioning

confidence: 99%

“…Regarding any kind of ICH, without differentiation between asymptomatic and symptomatic, or parenchymal and non-parenchymal, no significant differences between CPs and NCPs were reported in the majority of the relevant studies as well [ 8 , 10 , 11 , 17 , 20 , 22 ], with only one reporting significantly higher overall ICH rates (defined as subarachnoid or intraparenchymal), but no differences in regard to the type of ICH [ 13 ]. An additional CRS study also provided the rates of subarachnoid and parenchymal hemorrhages, showing no differences between CPs and NCPs [ 19 ], with these findings on the subarachnoid hemorrhages corroborated in a third study as well [ 8 ].…”

Section: Resultsmentioning

confidence: 99%

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

Aloizou

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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

Aloizou

Richter

James

et al. 2022

JCM

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Effects of tumor type on outcomes in patients with large vessel occlusion stroke and cancer

Shalabi¹,

Aladdin²,

Molad³

et al. 2023

Journal of Stroke and Cerebrovascular Diseases

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Does malignancy status effect outcomes in patients with large vessel occlusion stroke and cancer that underwent endovascular thrombectomy?

Shalabi

Sacagiu

Honig

et al. 2023

Preprint

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Background: Cancer is associated with an increased risk of acute ischemic stroke (AIS) including large vessel occlusions (LVO). Whether cancer status affects outcomes in patients with LVO that undergo endovascular thrombectomy (EVT) remains unknown. Methods and Results: All consecutive patients undergoing EVT for LVO were recruited into a prospective ongoing multi-center database and the data was retrospectively analyzed. Patients with active cancer were compared to patients with cancer in remission. Association of cancer status with 90-day functional outcome and mortality were calculated in multivariable analyses. We identified 154 patients with cancer and LVO that underwent EVT (mean age 74±11, 43% men, median NIHSS 15). Of the included patients, 70 (46%) had a remote history of cancer or cancer in remission and 84 (54%) had active disease. Outcome data at 90 days post-stroke was available for 138 patients (90%) and was classified as favorable in 53 (38%). Patients with active cancer were younger and more often smoked but did not significantly differ from those without malignancy in other risk factors, stroke severity, stroke subtype or procedural variables. Favorable outcome rates among patients with active cancer did not significantly differ compared to those seen in patients without active cancer but mortality rates were significantly higher among patients with active cancer on univariate and multivariable analyses. Conclusions: Our study suggests that EVT is safe and efficacious in patients with history of malignancy as well as in those with active cancer at the time of stroke onset although mortality rates are higher among patients with active cancer.

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Endovascular Therapy is Effective for Large Vessel Occlusion Despite Concurrent Cancer

Cited by 8 publications

References 29 publications

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

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

Effects of tumor type on outcomes in patients with large vessel occlusion stroke and cancer

Does malignancy status effect outcomes in patients with large vessel occlusion stroke and cancer that underwent endovascular thrombectomy?

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