Intra-arterial thrombectomy for acute ischaemic stroke patients with active cancer

Lee, Dongwhane; Lee, Deok Hee; Suh, Dae Chul; Kwon, Hyuk Sung; Jeong, Da-Eun; Kim, Joong-Goo; Lee, Jisung; Kim, Jong Seung; Kang, Dong‐Wha; Jeon, Sang-Beom; Lee, Eun‐Jae; Noh, Kyung Chul; Kwon, Sun U.

doi:10.1007/s00415-019-09416-8

Cited by 50 publications

(81 citation statements)

References 36 publications

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“…According to our analysis, most deaths within 3 months (77.8%) were related to cerebral infarction and occurred during hospitalization. Similar to our results, Lee et al reported that most deaths are caused by the ischemic stroke itself rather than the progression of cancer [12]. After stroke, anti-cancer therapy was usually stopped until the stroke stabilized.…”

Section: Discussionsupporting

confidence: 91%

“…Therefore, mechanical thrombectomy (MT) for occluded large vessels can be a particularly important treatment option for CRS patients [10,11]. However, although there have been earlier studies showing the overall outcomes of MT in patients with CRS [12][13][14][15][16][17], the effectiveness of MT on CRS remains controversial as patients with active cancer were excluded from previous important clinical trials [18][19][20][21]. To the best of our knowledge, there have not been any studies investigating the independent factors associated with the functional outcomes of CRS after MT.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome

et al. 2021

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Background The effectiveness of mechanical thrombectomy (MT) in cancer-related stroke (CRS) is largely unknown. This study aims to investigate the clinical and radiological outcomes of MT in CRS patients. We also explored the factors that independently affect functional outcomes of patients with CRS after MT. Methods We retrospectively reviewed 341 patients who underwent MT after acute ischemic stroke onset between May 2014 and May 2020. We classified the patients into CRS (n = 34) and control (n = 307) groups and compared their clinical details. Among CRS patients, we analyzed the groups with and without good outcomes (3-months modified Rankin scale [mRS] score 0, 1, 2). Multivariate analysis was performed to investigate the independent predictors of unfavorable outcomes in patients with CRS after MT. Results A total of 341 acute ischemic stroke patients received MT, of whom 34 (9.9%) had CRS. Although the baseline National institute of health stroke scale (NIHSS) score and the rate of successful recanalization was not significantly different between CRS patients and control group, CRS patients showed more any cerebral hemorrhage after MT (41.2% vs. controls 23.8%, p = 0.037) and unfavorable functional outcome at 3 months (CRS patients median 3-month mRS score 4, interquartile range [IQR] 2 to 5.25 vs. controls median 3-month mRS score 3, IQR 1 to 4, [p = 0.026]). In the patients with CRS, elevated serum D-dimer level and higher baseline NIHSS score were independently associated with unfavorable functional outcome at 3 months (adjusted odds ratio [aOR]: 1.524, 95% confidence interval [CI]: 1.043–2.226; aOR: 1.264, 95% CI: 1.010–1.582, respectively). Conclusions MT is an appropriate therapeutic treatment for revascularization in CRS patients. However, elevated serum D-dimer levels and higher baseline NIHSS scores were independent predictors of unfavorable outcome. Further research is warranted to evaluate the significance of these predictors.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome

et al. 2021

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“…If the exact onset time was unknown, it was defined as the point in time when the patient was lastly confirmed to be normal. EVTs were performed by one of two experienced neurointerventionists (DCS or DHL) as described elsewhere [ 22 ]. Endovascular procedures including direct stenting and/or balloon angioplasty, mechanical disruption, direct aspiration, and a stent retriever were employed appropriately at the discretion of the neurointerventionist.…”

Section: Methodsmentioning

confidence: 99%

“…EVTs were performed by one of two experienced neurointerventionists (DCS or DHL) as described elsewhere. 22 Endovascular procedures including direct stenting and/or balloon angioplasty, mechanical disruption, direct aspiration, and a stent retriever were employed appropriately at the discretion of the neurointerventionist. Moreover, the decision to treat proximal severe stenosis/occlusion first or distal embolism first in patients with AT-O depended on the operator.…”

Section: Endovascular Treatmentmentioning

confidence: 99%

Endovascular Treatment in Patients with Cerebral Artery Occlusion of Three Different Etiologies

Lee

Suh

et al. 2020

J Stroke

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Background and Purpose The outcome of endovascular treatment (EVT) may differ depending on the etiology of arterial occlusion. This study aimed to assess the differences in EVT outcomes in patients with intracranial arterial steno-occlusion (ICAS-O), artery-to-artery embolism (AT-O), and cardiac embolism (CA-O).<br/>Methods We retrospectively analyzed 330 patients with ischemic stroke who underwent EVT between January 2012 and August 2017. Patients were classified according to the etiology. The clinical data, EVT-related factors, and clinical outcomes were compared. The modified Rankin Scale (mRS) score at 3 months, determined using ordinal logistic regression (shift analysis), was the primary outcome.<br/>Results CA-O (n=149) was the most common etiology, followed by ICAS-O (n=63) and AT-O (n=49). Age, initial National Institutes of Health Stroke Scale (NIHSS) score, and rate of hemorrhagic transformation were significantly higher in patients with CA-O compared to AT-O and ICAS-O. The time from onset-to-recanalization was the shortest in the CA-O (356.0 minutes) groups, followed by the AT-O (847.0 minutes) and ICAS-O (944.0 minutes) groups. The rates of successful recanalization, mRS distribution, and favorable outcomes at 3 months (mRS 0–2; CA-O, 36.9%, AT-O, 53.1%; and ICAS-O, 41.3%) did not differ among the three groups. Baseline NIHSS score (odds ratio, 0.87; 95% confidence interval, 0.83 to 0.91) could independently predict a favorable shift in mRS distribution.<br/>Conclusions The functional outcomes of ICAS-O and AT-O were similar to those of CA-O, despite the delay in symptom onset-to-recanalization, suggesting that the therapeutic time window may be extended in these patients.

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“…However, the mortality after 3 months was more than double in patients with active cancer compared with that in controls (29.1 vs. 12.5%). Further, they concluded that active cancer per se was an independent predictor of a decrease in functional independence at 3 months (23). Both these reports did not show long-term (>12 months) prognosis in the patients of stroke who required EVT for AIS.…”

Section: Discussionmentioning

confidence: 93%

Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy

et al. 2020

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Endovascular thrombectomy (EVT) is the preferred treatment strategy for patients with acute ischemic stroke (AIS). However, clinical outcome and prognosis in patients who undergo EVT in response to AIS with concomitant malignancy have not been fully elucidated. Data of patients with malignancy who underwent EVT at participating institutions between January 2015 and April 2019 were retrospectively analyzed. Patient characteristics, treatment methods, posttreatment strategy, and long-term prognosis were evaluated in 12 patients with prediagnoses of malignancy. Good revascularization (TICI 2b or higher) was achieved in 10 of 12 patients. Among the eight patients who survived more than 2 weeks from onset, four patients showed good clinical outcome [modified Rankin Scale (mRS) <2] at 60 days posttreatment and were able to continue treatment for malignancy. However, seven of eight patients died within a year of EVT (median survival, 83 days) due to progression of malignancy. One-year survival was achieved in only one patient whose etiology of stroke was determined as infectious endocarditis and not Trousseau syndrome. Even after successful revascularization and good short-term clinical outcome, the long-term prognosis after thrombectomy in patients with malignancy was poor. Thrombectomy for concomitant malignancy requires judicious decision, and further studies are necessary to fully elucidate its efficacy.

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Intra-arterial thrombectomy for acute ischaemic stroke patients with active cancer

Cited by 50 publications

References 36 publications

Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome

Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome

Endovascular Treatment in Patients with Cerebral Artery Occlusion of Three Different Etiologies

Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy

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