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Elmarawany MN, El Malky I, Winklhofer S, Katan M, Kar S, Baltsavias G. Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke in Cancer Patients: A Single-Center Experience and Meta-Analysis. Neurol Clin Pract 2024; 14:e200320. [PMID: 38868837 PMCID: PMC11165561 DOI: 10.1212/cpj.0000000000200320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/11/2024] [Indexed: 06/14/2024]
Abstract
Background and Objectives The published data about mechanical thrombectomy (MT) in cancer patients is sparse. We present our institutional experience in this clinical scenario, and a meta-analysis. Methods The baseline data, procedural data, clinical and radiological outcomes of MT were analyzed and compared among three groups of stroke patients: controls, patients with active malignancy (AM), and patients with history of malignancy (HOM). A meta-analysis of 12 studies was conducted to address the differences between controls and AM patients regarding selected outcomes. Results The 3 groups (controls, AM, HOM) showed significant differences regarding previous history of stroke or TIA (7.8% vs 10.5% vs 38.5%, p = 0.006), alcohol consumption (0.9% vs 10.5% vs 0.0%, p = 0.04), thrombophilia (1.7% vs 15.8% vs 7.7%, p = 0.009), deep venous thrombosis (0.4 vs 26.3% vs 7.7%, p = 0.005). The AM group had significantly higher rates of sICH (3.5% [controls] vs 21.1% [AM] vs 0.0% [HOM], p = 0.007), and mortality at 3 months (27.5% [controls] vs 61.5% [AM] vs 40.0% [HOM] vs, p = 0.032). The control and HOM groups had significantly better functional independence at 3 months (52.1% [controls] vs 15.4% [AM] vs 60.0% [HOM], p = 0.032).In the meta-analysis, the AM arm showed significantly higher mortality during hospitalization (n = 6, OR 95% CI = 3.03 [1.62, 5.64]), and at 3 months (n = 10, OR 95% CI = 4.33 [2.80, 6.68]), and significantly lower rates of 3 months functional independence (mRS = 0-2) (n = 10, OR 95% CI = 0.47 [0.32, 0.70]). No significant difference was found in sICH rates (n = 6, pooled OR 95% CI = 2.03 [0.83, 4.95]). Discussion Endovascular MT is technically successful and reasonably safe in treating AIS from LVO in active malignancy patients. However, the causes and implications of sICH require further investigation. Despite technical success, these patients experience poor clinical outcomes, and the long-term benefits of MT remain uncertain.
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Affiliation(s)
- Mohamed N Elmarawany
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
| | - Islam El Malky
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
| | - Sebastian Winklhofer
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
| | - Mira Katan
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
| | - Souvik Kar
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
| | - Gerasimos Baltsavias
- Department of Neuroradiology (MNE, IEM, SW, MK, GB), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; Department of Neurosurgery (MNE), Faculty of Medicine, Menoufia University; Department of Neurology (IEM), Faculty of Medicine, South valley University, Egypt; Department of Neurology (MK), Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and International Neuroscience Institute (SK, GB), Hannover, Germany
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Włodarczyk E, Wrona P, Homa T, Sobolewska M, Wróbel D, Rolkiewicz D, Popiela T, Słowik A, Sawczyńska K. Long-term outcomes of mechanical thrombectomy in acute ischaemic stroke patients with concomitant malignancy. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:95-102. [PMID: 38616929 PMCID: PMC11008522 DOI: 10.5114/aic.2024.137433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Patients with cancer (CP) need a different approach to acute ischaemic stroke (AIS) treatment as intravenous thrombolysis (IVT) may be contraindicated. Mechanical thrombectomy (MT) is a treatment of choice for otherwise eligible patients, although the literature on its long-term outcomes in CP is limited. Aim Assessing outcomes of MT-treated AIS patients with concomitant malignancy in a year-long follow-up. Material and methods The study included 593 MT-treated AIS patients admitted in 2019-2021. The group was divided into CP (defined as a diagnosis of malignancy and undergoing/qualified for cancer treatment within previous 5 years) and a control group. The profile of cardiovascular risk factors, stroke severity and discharge, 90-day and 365-day outcomes were compared between the groups. Results CP and controls had a similar profile of cardiovascular risk factors and comparable stroke severity. CP were less frequently treated with IVT (25.7% vs. 59.1%, p < 0.001). There were no differences between the groups in the successful reperfusion rate and occurrence of haemorrhagic complications. Discharge and 90-day outcomes were similar. CP had higher 365-day mortality (48.6% vs. 29.9%, p = 0.024) but the percentage of patients achieving good functional outcome in a year-long observation was comparable. Conclusions Treatment with MT seems beneficial for AIS patients with concomitant malignancy both in short- and long-term observation.
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Affiliation(s)
- Ewa Włodarczyk
- Department of Neurology, University Hospital, Krakow, Poland
| | - Paweł Wrona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Homa
- Department of Neurology, University Hospital, Krakow, Poland
| | - Maria Sobolewska
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Dominik Wróbel
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Rolkiewicz
- Student Scientific Group in Cerebrovascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Wada S, Yoshimura S, Toyoda K, Nakai M, Sasahara Y, Miwa K, Koge J, Ishigami A, Shiozawa M, Ogasawara K, Kitazono T, Nogawa S, Iwanaga Y, Miyamoto Y, Minematsu K, Koga M. Characteristics and outcomes of unknown onset stroke: The Japan Stroke Data Bank. J Neurol Sci 2023; 453:120798. [PMID: 37729754 DOI: 10.1016/j.jns.2023.120798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Clinical outcomes of unknown onset stroke (UOS) are influenced by the enlargement of the therapeutic time window for reperfusion therapy. This study aimed to investigate and describe the characteristics and clinical outcomes of patients with UOS. METHODS Patients with acute ischemic stroke (AIS) who were admitted within 24 h of their last known well time, from January 2017 to December 2020, were included. Data were obtained from a long-lasting nationwide hospital-based multicenter prospective registry: the Japan Stroke Data Bank. The co-primary outcomes were the National Institutes of Stroke Scale (NIHSS) scores on admission and unfavorable outcomes at discharge, corresponding to modified Rankin Scale (mRS) scores of 3-6. RESULTS Overall, 26,976 patients with AIS were investigated. Patients with UOS (N = 5783, 78 ± 12 years of age) were older than patients with known onset stroke (KOS) (N = 21,193, 75 ± 13 years of age). Age, female sex, higher premorbid mRS scores, atrial fibrillation, and congestive heart failure were associated with UOS in multivariate analysis. UOS was associated with higher NIHSS scores (median = 8 [interquartile range [IQR]: 3-19] vs. 4 [1-10], adjusted incidence rate ratio = 1.37 [95% CI: 1.35-1.38]) and unfavorable outcomes (52.1 vs. 33.6%, adjusted odds ratio = 1.27 [1.14-1.40]). Intergroup differences in unfavorable outcomes were attenuated among females (1.12 [0.95-1.32] vs. males 1.38 [1.21-1.56], P = 0.040) and in the subgroup that received reperfusion therapy (1.10 [0.92-1.33] vs. those who did not receive therapy 1.23 [1.08-1.39], P = 0.012). CONCLUSIONS UOS was associated with unfavorable outcomes but to a lesser degree among females and patients receiving reperfusion therapy.
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Affiliation(s)
- Shinichi Wada
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yusuke Sasahara
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akiko Ishigami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Nogawa
- Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Mosconi MG, Capponi A, Paciaroni M. Systemic thrombolysis in patients with acute stroke and active cancer: a systematic review and meta-analysis. Intern Emerg Med 2023; 18:1843-1850. [PMID: 37337013 DOI: 10.1007/s11739-023-03312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/11/2023] [Indexed: 06/21/2023]
Abstract
Cancer patients frequently have concomitant cerebrovascular diseases, which significantly worsen their prognosis. Prospective studies validating intravenous thrombolysis (IVT) safety profile in patients with acute ischemic stroke and active cancer are still lacking. Therefore, we aimed to evaluate IVT's efficacy and safety profile in acute ischemic stroke patients with comorbid active cancer. We included in a meta-analysis all relevant published studies, including patients with acute ischemic stroke with or without active cancer and receiving IVT, according to recommendations for IVT treatment for acute ischemic stroke. The primary outcomes were: any intracerebral hemorrhage, all-cause mortality, and good functional outcome reported as modified Rankin Scale (mRS) ≤ 2 at the end of the scheduled follow-up period. We included 11 studies in the meta-analysis. IVT was not associated with a significant increase in the incidence of intracerebral hemorrhage (OR 1.35; 95% CI 0.85-2.14; I2 76%), nor with a significant increase in death for any cause (OR 1.26; 95% CI 0.91-1.75; I2 71%); furthermore, IVT did not influence mRS between cancer and non-active cancer stroke patients (OR 0.72; 95% CI 0.35-1.49; I2 59%). IVT seems safe and effective in patients with ischemic stroke and concomitant cancer. Due to the low overall quality of the evidence, high-quality randomized controlled trials with adequate sample sizes are needed.
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Affiliation(s)
- Maria Giulia Mosconi
- Internal and Vascular and Emergency Medicine-Stroke Unit, Università degli Studi di Perugia/Azienda Ospedaliera Santa Maria della Misericordia, 06129, Perugia, Italy.
| | - Andrea Capponi
- Emergency Department, University of Florence, Florence, Italy
| | - Maurizio Paciaroni
- Internal and Vascular and Emergency Medicine-Stroke Unit, Università degli Studi di Perugia/Azienda Ospedaliera Santa Maria della Misericordia, 06129, Perugia, Italy
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Seystahl K, Gramatzki D, Wanner M, Weber SJ, Hug A, Luft AR, Rohrmann S, Wegener S, Weller M. A risk model for prediction of diagnosis of cancer after ischemic stroke. Sci Rep 2023; 13:111. [PMID: 36596831 PMCID: PMC9810715 DOI: 10.1038/s41598-022-26790-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
It remains controversial which characteristics may predict occult cancer in stroke patients. Characteristics of patients with ischemic stroke registered in the Zurich Swiss Stroke Registry (2014 to 2016) were tested for associations with cancer diagnosis after stroke with consideration of death as competing risk for cancer diagnosis. Among 1157 patients, 34 (3%) and 55 patients (5%) were diagnosed with cancer within 1 and 3 years after stroke. Levels of white blood cells (WBC) > 9,600/µl (subdistribution hazard ratio (SHR) 3.68, p = 0.014), platelets > 400,000/µl (SHR 7.71, p = 0.001), and d-dimers ≥ 3 mg/l (SHR 3.67, p = 0.007) were independently associated with cancer diagnosis within 1 year after stroke. Occurrence of ischemic lesions in ≥ 2 vascular territories not attributed to cardioembolic etiology was associated with cancer diagnosed within 1 year after stroke in univariable analysis (SHR 3.69, p = 0.001). The area under the curve of a score from these parameters (score sum 0-4) was 0.73. A score of ≥ 2 had a sensitivity of 43% and specificity of 92% for prediction of cancer diagnosis within 1 year after stroke. We suggest further validation of a score of WBC, platelets, d-dimers and multiple ischemic lesions without cardioembolic stroke etiology for prediction of cancer diagnosis after stroke.
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Affiliation(s)
- Katharina Seystahl
- grid.7400.30000 0004 1937 0650Department of Neurology, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland
| | - Dorothee Gramatzki
- grid.7400.30000 0004 1937 0650Department of Neurology, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland
| | - Miriam Wanner
- grid.7400.30000 0004 1937 0650Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen and Schwyz, University Hospital and University of Zurich, Zurich, Switzerland
| | - Sung Ju Weber
- grid.7400.30000 0004 1937 0650Department of Neurology, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland
| | - Alessia Hug
- grid.7400.30000 0004 1937 0650Department of Neurology, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland
| | - Andreas R. Luft
- grid.7400.30000 0004 1937 0650Department of Neurology, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland ,grid.512634.7Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Sabine Rohrmann
- grid.7400.30000 0004 1937 0650Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen and Schwyz, University Hospital and University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- grid.7400.30000 0004 1937 0650Department of Neurology, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland
| | - Michael Weller
- grid.7400.30000 0004 1937 0650Department of Neurology, University Hospital and University of Zurich, CH-8091 Zurich, Switzerland
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Cancer and stroke: What do we know and where do we go? Thromb Res 2022; 219:133-140. [PMID: 36179651 DOI: 10.1016/j.thromres.2022.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
Cancer is an increasingly recognized cause for ischemic stroke, with recent acknowledgement of cancer-related stroke as an emerging stroke subtype with unique pathophysiologic mechanisms. In addition, cancer-related stroke may differ from stroke in the general population as cancer patients may not receive guideline-recommended stroke care, and the occurrence of stroke may also preclude patients from receiving optimal cancer treatments. Due to the high degree of morbidity and mortality associated with both conditions, understanding the relationship between stroke and cancer is crucial. In this narrative review, we discuss the association between cancer and stroke, the unique pathophysiologic mechanisms underlying this phenomenon, treatment options including acute reperfusion therapies and secondary prevention strategies, compare outcomes between cancer-related stroke and stroke in the general population, and review new and emerging evidence in this field.
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Caimano D, Letteri F, Capasso F, Limbucci N, Nencini P, Sarti C, Alemseged F, Bigliardi G, Morotti A, Toni D, Zini A, Arba F. Endovascular treatment in patients with acute ischemic stroke and cancer: Systematic review and meta-analysis. Eur Stroke J 2022; 7:204-211. [PMID: 36082266 PMCID: PMC9446332 DOI: 10.1177/23969873221100897] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Although stroke occurs frequently in patients with cancer, there is scarce evidence regarding the safety and efficacy of endovascular treatment (EVT) in patients with acute ischemic stroke and concurrent cancer. We performed a systematic review and meta-analysis to summarize the existing literature. METHODS We searched for English written observational studies reporting data on safety and efficacy of EVT in patients with acute ischemic stroke and concurrent cancer. Outcomes of interest were: functional independence (modified Rankin Scale (mRS) ⩽ 2); mortality at 3 months; rate of successful recanalization (modified Treatment In Cerebral Ischemia (mTICI) 2b or 3); occurrence of any hemorrhagic transformation (both symptomatic and asymptomatic). We pooled data with Maentel-Haenszel model to calculate cumulative odds ratios (ORs). RESULTS We included seven studies with a total of 4465 patients, of whom 262 (6%) with cancer. We observed various definitions of cancer across included studies. Patients with cancer had less likely mRS⩽2 at 3 months (24% vs 42%, OR = 0.44; 95% CI = 0.32-0.60) and increased probability of death (43% vs 19%, OR = 5.02; 95% CI = 2.90-8.69). There was no difference in successful recanalization (70% vs 75%, OR = 0.84; 95% CI = 0.49-1.44); patients with cancer had increased risk of any intracerebral hemorrhage after treatment (49% vs 34%, OR = 1.95; 95% CI = 1.28-2.96), though not for symptomatic ICH (OR 1.04; 95% CI = 0.59-1.85). CONCLUSION Patients with acute ischemic stroke and cancer have similar EVT recanalization but higher probability of functional dependence, death, and any hemorrhagic transformation, though not necessarily symptomatic, compared with patients without cancer. Our results may help communication with patients and carers.
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Affiliation(s)
- Danilo Caimano
- NEUROFARBA Department, University of
Florence, Firenze, Italy
| | | | - Francesco Capasso
- Neurovascular Interventional Unit,
Careggi University Hospital, Firenze, Italy
| | - Nicola Limbucci
- Neurovascular Interventional Unit,
Careggi University Hospital, Firenze, Italy
| | | | - Cristina Sarti
- NEUROFARBA Department, University of
Florence, Firenze, Italy
| | - Fana Alemseged
- Department of Medicine and Neurology,
Royal Melbourne Hospital, University of Melbourne, Australia
| | - Guido Bigliardi
- Neurology Clinic – Stroke Unit,
Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena,
Italy
| | - Andrea Morotti
- Dipartimento di Scienze Neurologiche e
della Visione, Clinica Neurologica, ASST Spedali Civili di Brescia, Brescia,
Italy
| | - Danilo Toni
- Neurological Sciences, University of
Rome La Sapienza, Roma, Italy
| | - Andrea Zini
- Department of Neurology and Stroke
Center, IRCCS Istituto delle Scienze Neurologiche, Maggiore Hospital, Bologna,
Italy
| | - Francesco Arba
- Stroke Unit, Careggi University
Hospital, Firenze, Italy
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Mechanical Thrombectomy for Acute Ischemic Stroke in Patients with Malignancy: A Systematic Review. J Clin Med 2022; 11:jcm11164696. [PMID: 36012933 PMCID: PMC9410462 DOI: 10.3390/jcm11164696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
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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