Temporal Trends in the Use of Acute Recanalization Therapies for Ischemic Stroke in Patients with Cancer

Chatterjee, Abhinaba; Merkler, Alexander E; Murthy, Santosh B.; Burch, Jaclyn E; Chen, Monica L.; Gialdini, Gino; Kamel, Hooman; Ballman, Karla V.; Navi, Babak B.

doi:10.1016/j.jstrokecerebrovasdis.2019.05.009

Cited by 13 publications

(16 citation statements)

References 34 publications

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“…In our analysis, patients with active malignancy are one-third less likely to receive IV tPA. In a previous study by Chatterjee et al ,36 patients with active malignancy received IV thrombolytic therapy about two-thirds as often as patients without active malignancy. By contrast, no difference was found in the use of EVT in patients with and without active malignancy; however, the annual rates of EVT and IV thrombolysis utilization are low.…”

Section: Discussionmentioning

confidence: 94%

Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis

Jhou

Yang

Chen

et al. 2022

J NeuroIntervent Surg

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BackgroundActive malignancy has a poorer prognosis and more deaths in patients with acute ischemic stroke (AIS). The outcomes of endovascular therapy (EVT) remain controversial in patients with AIS and active malignancy.MethodsWe searched PubMed, Cochrane, and Embase for articles published up to June 1, 2022. The primary outcome was good functional outcome at 3 months and successful reperfusion between patients with cancer and AIS and control patients. The secondary and safety outcomes included mortality at 3 months, in-hospital mortality, symptomatic intracerebral hemorrhage (sICH), any ICH, and subarachnoid hemorrhage (SAH).ResultsTwelve studies involving 5944 patients with AIS secondary to EVT were included (389 patients having active malignancy). The OR of good functional outcome at 3 months was 0.53 (95% CI 0.41 to 0.67) between the two groups. The OR of successful reperfusion between the two groups was 0.90 (95% CI 0.63 to 1.30). Compared with patients without cancers, those with cancers had a higher risk of mortality at 3 months (OR 3.64; 95% CI 2.35 to 6.27) and in-hospital mortality (OR 3.46; 95% CI 1.71 to 7.01). Despite a higher point estimate regarding any ICH (OR 1.41; 95% CI 1.01 to 1.96) and SAH (OR 2.53; 95% CI 1.10 to 5.81), sICH (OR 0.85; 95% CI 0.51 to 1.42) was not significant.ConclusionAlthough a quarter of patients with active malignancy and AIS regained functional independence, physicians and patients should consider whether to apply EVT in patients with active malignancy.

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Section: Discussionmentioning

confidence: 94%

Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis

Jhou

Yang

Chen

et al. 2022

J NeuroIntervent Surg

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“…Recently, a retrospective analysis of a large nationwide sample of inpatient hospitalizations from 1998 to 2015 showed that cancer patients with AIS received intravenous thrombolysis (IVT) about two thirds as often as AIS patients without cancer. Differently, use of mechanical thrombectomy (MT) was similar between patients with and without cancer during the study period 8 .…”

Section: Introductionmentioning

confidence: 99%

Recanalisation theraphy for acute ischemic stroke in cancer patients

Merlino

Smeralda

Gigli

et al. 2021

Sci Rep

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To date, very few studies focused their attention on efficacy and safety of recanalisation therapy in acute ischemic stroke (AIS) patients with cancer, reporting conflicting results. We retrospectively analysed data from our database of consecutive patients admitted to the Udine University Hospital with AIS that were treated with recanalisation therapy, i.e. intravenous thrombolysis (IVT), mechanical thrombectomy (MT), and bridging therapy, from January 2015 to December 2019. We compared 3-month dependency, 3-month mortality, and symptomatic intracranial haemorrhage (SICH) occurrence of patients with active cancer (AC) and remote cancer (RC) with that of patients without cancer (WC) undergoing recanalisation therapy for AIS. Patients were followed up for 3 months. Among the 613 AIS patients included in the study, 79 patients (12.9%) had either AC (n = 46; 7.5%) or RC (n = 33; 5.4%). Although AC patients, when treated with IVT, had a significantly increased risk of 3-month mortality [odds ratio (OR) 6.97, 95% confidence interval (CI) 2.42–20.07, p = 0.001] than WC patients, stroke-related deaths did not differ between AC and WC patients (30% vs. 28.8%, p = 0.939). There were no significant differences between AC and WC patients, when treated with MT ± IVT, regarding 3-month dependency, 3-month mortality and SICH. Functional independence, mortality, and SICH were similar between RC and WC patients. In conclusion, recanalisation therapy might be used in AIS patients with nonmetastatic AC and with RC. Further studies are needed to explore the outcome of AIS patients with metastatic cancer undergoing recanalisation therapy.

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“…An acute ischemic stroke (AIS) is a neurological emergency stemming from the acute obstruction of blood flow in a cerebral territory. A plethora of predisposing health conditions are known, for instance, atrial flatter, carotid disease, diabetes, and smoking, but the presence of an underlying malignancy also seems to increase the risk of AIS, with 1 in 20 hospitalized AIS patientshaving a concurrent malignancy [ 1 ]. AIS can occur in cancer patients due to several different factors, such as hypercoagulability and platelet disorders, or as a result of cancer therapies, namely chemotherapy [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Though cancer per se is no contraindication for administering IVT, contraindications, such as low platelet counts, recent surgeries, and active hemorrhages, are more often encountered in cancer patients (CPs), so MT often remains the only recanalization modality when applicable [ 4 ]. As an interesting temporal trends study showed, though both methods demonstrated an increase in time, cancer patients received MT at similar rates compared to non-cancer patients, whereas IVT was administered in about two-thirds of the cases of cancer patients compared to non-cancer ones [ 1 ]. There is a general paucity of high-quality data on whether these treatment modalities are safe and effective in patients with cancer, and most guidelines do not make any particular mention of malignancy.…”

Section: Introductionmentioning

confidence: 99%

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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Temporal Trends in the Use of Acute Recanalization Therapies for Ischemic Stroke in Patients with Cancer

Cited by 13 publications

References 34 publications

Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis

Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis

Recanalisation theraphy for acute ischemic stroke in cancer patients

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

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