Mechanical Thrombectomy for Acute Ischemic Stroke in Metastatic Cancer Patients: A Nationwide Cross-Sectional Analysis

• Authors: Hassan Aboul-Nour, Emory University; Ahmed Maraey, CHI St. Alexius Health; Ammar Jumah, Henry Ford Hospital; Mahmoud Khalil, Lincoln Medical and Mental Health Center; Ahmed M Elzanaty, University of Toledo; Hadeer Elsharnoby, Carle Foundation Hospital; Fawaz Al-Mufti, New York Medical College; Alex Bou Chebl, Henry Ford Hospital; Daniel J Miller, Henry Ford Hospital; Stephan A Mayer, New York Medical College
• Journal Title: Journal of Stroke
• Volume: Volume 25, Number 1
• Publisher: Korean Stroke Society | 2023-01-03, Pages 119-125
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.5853/jos.2022.02334
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Stroke; Cancer; Metastases; Thrombectomy; Database

Abstract

Background and Purpose Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials. Methods We searched the National Readmission Database for LVO patients treated with MT between 2016–2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders. Results Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P<0.001). Patients with MC had similar rates of intracerebral hemorrhage (20% vs. 21%) but were less likely to receive tissue plasminogen activator (13% vs. 23%, P<0.001). In unadjusted analysis, MC patients as compared to cancer-free patients had a higher in-hospital mortality rate and were less likely to be discharged to home (36% vs. 42%, P=0.014). On multivariate regression adjusting for confounders, mortality was the only outcome that was significantly higher in the MC group than in the cancerfree group (P<0.001). Conclusion LVO patients with MC have higher mortality and more infectious and thrombotic complications than cancer-free patients. MT nonetheless can result in survival with good outcome in slightly over one-third of patients.