Fibrin and Platelet-Rich Composition in Retrieved Thrombi Hallmarks Stroke With Active Cancer

Fu, Chuan-Hsiu; Chen, Chih‐Hao; Lin, Yen‐Heng; Lee, Chung-Wei; Tsai, Li-Kai; Tang, Sung‐Chun; Shun, Chia‐Tung; Jeng, Jiann‐Shing

doi:10.1161/strokeaha.120.032069

Cited by 29 publications

(35 citation statements)

References 8 publications

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“…This mechanism results in the formation of a solid fibrin clot within the vessel without any embolic thrombus. A previous study revealed that thrombi from EVT in cancer patients showed a significantly higher fraction of platelets and fibrin-rich components than those in non-cancer stroke patients ( 15 , 16 ). D -dimer could be directly related to circulating tumor cells in cancer stroke patients as well ( 17 ).…”

Section: Discussionmentioning

confidence: 90%

Significance of D-Dimer in Acute Ischemic Stroke Patients With Large Vessel Occlusion Accompanied by Active Cancer

et al. 2022

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BackgroundThis study aimed to investigate clinical outcome predictors of acute stroke patients with large vessel occlusion and active cancer and validate the significance of D-dimer levels for endovascular thrombectomy decisions.MethodsWe analyzed a prospectively collected hospital-based stroke registry to determine clinical EVT outcomes of acute stroke patients within 24 h with following criteria: age ≥18 years, NIHSS ≥6, and internal carotid artery or middle cerebral artery lesion. All patients were classified into EVT and non-EVT groups. Patients were divided into two groups by initial D-dimer level. We explored variables potentially associated with successful recanalization as well as 3-month functional outcomes and mortality rates.ResultsAmong 68 patients, 36 were treated with EVT, with successful recanalization in 55.6%. The low D-dimer group showed a higher rate of successful recanalization and favorable outcome than the high D-dimer group. The mortality rate was higher in the high D-dimer group. No EVT and high D-dimer level were independent predictors of mortality, whereas lesion volume and low D-dimer level were independently associated with favorable outcomes.ConclusionsD-dimer level is a prognostic factor in acute LVO stroke patients with active cancer, and its high value for EVT decisions provisionally supports its testing in this patient population.

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Section: Discussionmentioning

confidence: 90%

Significance of D-Dimer in Acute Ischemic Stroke Patients With Large Vessel Occlusion Accompanied by Active Cancer

et al. 2022

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“…Because these findings did not change after factoring in reperfusion success, other factors must have contributed to cause worse outcomes in patients in whom the SVS was absent. We hypothesized that atypical thrombi (septic 28 or neoplastic 29,30 ), which are likely to contain few erythrocytes 31 and develop after a preceding illness, could be part of the explanation. However, in an additional sensitivity analysis, clinical outcome remained worse for the SVS-group when patients with prestroke dependency (mRS .…”

Section: Discussionmentioning

confidence: 99%

SWI Susceptibility Vessel Sign in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke

Belachew¹,

Dobrocky²,

Aleman³

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The frequency and clinical significance of the susceptibility vessel sign in patients with acute ischemic stroke remains unclear. We aimed to assess its prevalence in patients with acute ischemic stroke undergoing mechanical thrombectomy and to analyze its association with interventional and clinical outcome parameters in that group.MATERIALS AND METHODS: Six hundred seventy-six patients with acute ischemic stroke and admission MR imaging were reviewed retrospectively. Of those, 577 met the eligibility criteria for further analysis. Imaging was performed using a 1.5T or 3T MR imaging scanner. Associations between baseline variables, interventional and clinical outcome parameters, and susceptibility vessel sign were determined with multivariable logistic regression models. Results are shown as adjusted ORs with 95% CIs. RESULTS:The susceptibility vessel sign was present in 87.5% (n = 505) of patients and associated with tandem occlusion (adjusted OR, 3.3; 95% CI, 1.1-10.0; P ¼ .032) as well as successful reperfusion, defined as an expanded TICI score of $2b (adjusted OR, 2.4; 95% CI, 1.28-4.6; P ¼ .007). The susceptibility vessel sign was independently associated with functional independence (mRS # 2: adjusted OR, 2.1; 95% CI, 1.1-4.0; P ¼ .028) and lower mortality (adjusted OR, 0.4; 95% CI, 0.2-0.7; P ¼ .003) at 90 days, even after adjusting for successful reperfusion. The susceptibility vessel sign did not influence the number of passes performed during mechanical thrombectomy, the first-pass reperfusion, or the risk of peri-or postinterventional complications. CONCLUSIONS:The susceptibility vessel sign is an MR imaging phenomenon frequently observed in patients with acute ischemic stroke and is associated with successful reperfusion after mechanical thrombectomy. However, superior clinical functional outcome and lower mortality noted in patients showing the susceptibility vessel sign could not be entirely attributed to higher reperfusion rates.

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“…A previous study revealed that thrombi from EVT in cancer patients showed a signi cantly higher fraction of platelets and brin-rich components than those in non-cancer stroke patients. 13,14 . Further studies are needed to reveal the speci c mechanism in cancer stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Title: Significance of D-dimer in acute ischemic stroke patients with large vessel occlusion accompanied by active cancer

Pan

Kim

Chung

et al. 2021

Preprint

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Background: This study aimed to investigate clinical outcome predictors of acute stroke patients with large vessel occlusion and active cancer and validate the significance of d-dimer levels for endovascular thrombectomy decisions.Methods: We analyzed a prospectively collected hospital-based stroke registry to determine clinical EVT outcomes of acute stroke patients within 24 hours with following criteria: age≥18 years, NIHSS≥6, and internal carotid artery or middle cerebral artery lesion. All patients were classified into EVT and non-EVT groups. Patients were divided into two groups by initial d-dimer level. We explored variables potentially associated with successful recanalization as well as 3-month functional outcomes and mortality rates. Results: Among 68 patients, 36 were treated with EVT, with successful recanalization in 55.6%. The low d-dimer group showed a higher rate of successful recanalization and favorable outcome than the high d-dimer group. The mortality rate was higher in the high d-dimer group. EVT and high d-dimer level were independent predictors of mortality, whereas lesion volume and low d-dimer level were independently associated with favorable outcomes.Conclusions: d-dimer level is a prognostic factor in acute LVO stroke patients with active cancer, and its high value for EVT decisions provisionally supports its testing in this patient population.

show abstract

Fibrin and Platelet-Rich Composition in Retrieved Thrombi Hallmarks Stroke With Active Cancer

Cited by 29 publications

References 8 publications

Significance of D-Dimer in Acute Ischemic Stroke Patients With Large Vessel Occlusion Accompanied by Active Cancer

Significance of D-Dimer in Acute Ischemic Stroke Patients With Large Vessel Occlusion Accompanied by Active Cancer

SWI Susceptibility Vessel Sign in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke

Title: Significance of D-dimer in acute ischemic stroke patients with large vessel occlusion accompanied by active cancer

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