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Abstract

Objective

Embolism due to coagulopathy might be the main pathomechanism underlying cancer-related stroke (CRS). CRS patients with a large artery occlusion could be candidates for endovascular recanalization therapy (ERT), although its procedural and clinical outcomes are not well known. This study aimed to investigate the procedural and clinical outcomes of ERT in CRS patients and the characteristics associated with outcomes compared with those of conventional stroke patients.

Methods

A registry of consecutive acute ischemic stroke patients who underwent ERT between January 2011 and October 2015 was retrospectively reviewed. CRS patients are described as those who had (a) cryptogenic stroke with advanced or metastatic cancer; (b) no other possible causes of stroke such as cardioembolism (CE) and large artery atherosclerosis (LAA); and (c) elevated D-dimer levels or diffusion-restricted lesions in multiple vascular territories. We compared procedural and clinical outcomes at discharge among CRS, CE, and LAA patients.

Results

A total of 329 patients were finally enrolled in this study; of these, 19 were CRS patients. The rate of successful recanalization, defined as modified treatment in cerebral infarction grade 2b or 3, was lower in the CRS group than in the LAA and CE groups (63% versus 84% versus 84%, p = .06). CRS subtype was an independent predictor for successful recanalization after ERT in the multivariate analysis (odds ratio, 0.317; 95% confidence interval, 0.116–0.867; p < .001). No significant difference in the rate of good clinical outcomes at discharge was observed among groups.

Conclusions

Although clinical outcomes at discharge were similar for CE and LAA patients, complete recanalization seemed more difficult to achieve in CRS patients than in conventional stroke patients.

Keywords

Cancer stroke thrombectomy recanalization

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References

Graus

Rogers

Posner

. Cerebrovascular complications in patients with cancer. Medicine (Baltimore) 1985; 64: 16–35.

Kim

Hong

Kim

et al.

Ischemic stroke in cancer patients with and without conventional mechanisms: a multicenter study in Korea. Stroke 2010; 41: 798–801.

Murthy

Karanth

Shah

et al.

Thrombolysis for acute ischemic stroke in patients with cancer: a population study. Stroke 2013; 44: 3573–3576.

Goyal

Menon

van Zwam

et al.

Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–1731.

Adams

Bendixen

Kappelle

et al.

Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35–41.

Kim

Park

Lee

M-J

et al.

Clues to occult cancer in patients with ischemic stroke. PLoS One 2012; 7: e44959.

Kang

D-H

Hwang

Y-H

Kim

Y-S

et al.

Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forced-suction thrombectomy in acute ischemic stroke. AJNR Am J Neuroradiol 2011; 32: 283–287.

Flacke

Urbach

Keller

et al.

Middle cerebral artery (MCA) susceptibility sign at susceptibility-based perfusion MR imaging: clinical importance and comparison with hyperdense MCA sign at CT. Radiology 2000; 215: 476–482.

Cho

K-H

Kim

Kwon

et al.

Significance of susceptibility vessel sign on T2*-weighted gradient echo imaging for identification of stroke subtypes. Stroke 2005; 36: 2379–2383.

10.

Zaidat

Yoo

Khatri

et al.

Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 2013; 44: 2650–2663.

11.

Merkler

Marcus

Gupta

et al.

Endovascular therapy for acute stroke in patients with cancer. Neurohospitalist 2014; 4: 133–135.

12.

Schwarzbach

Schaefer

Ebert

et al.

Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology. Stroke 2012; 43: 3029–3034.

13.

Seok

Kim

et al.

Coagulopathy and embolic signal in cancer patients with ischemic stroke. Ann Neurol 2010; 68: 213–219.

14.

S-H

Chen

W-H

Tang

et al.

Incidence of ischemic stroke post-chemotherapy: a retrospective review of 10,963 patients. Clinical Neurol Neurosurg 2006; 108: 150–156.

15.

Kwon

H-M

Kang

Yoon

B-W

. Stroke as the first manifestation of concealed cancer. J Neurol Sci 2007; 258: 80–83.

16.

Grisold

Oberndorfer

Struhal

. Stroke and cancer: a review. Acta Neurol Scand 2009; 119: 1–16.

17.

Bourcier

Volpi

Guyomarch

et al.

Susceptibility vessel sign on MRI predicts favorable clinical outcome in patients with anterior circulation acute stroke treated with mechanical thrombectomy. AJNR Am J Neuroradiol 2015; 36: 2346–2353.

18.

Eiken

Edwards

Tazelaar

et al.

Surgical pathology of nonbacterial thrombotic endocarditis in 30 patients, 1985–2000. Mayo Clin Proc 2001; 76: 1204–1212.

19.

Lee

Hong

Lee

et al.

Primary stent retrieval for acute intracranial large artery occlusion due to atherosclerotic disease. J Stroke 2016; 18: 96–101.

20.

Telischak

Wintermark

. Imaging predictors of procedural and clinical outcome in endovascular acute stroke therapy. Neurovasc Imaging 2015; 1: 4–16.

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Procedural and clinical outcomes of endovascular recanalization therapy in patients with cancer-related stroke

Abstract

Objective

Methods

Results

Conclusions

Keywords

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References

Supplementary Material