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

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Abstract

Background and purpose

This study aimed to evaluate the efficacy of intra-arterial thrombectomy (IAT) and prognosis for acute ischaemic stroke patients with active cancer.

Methods

We retrospectively reviewed 253 patients who underwent IAT within 24 h after stroke onset between January 2012 and August 2017. We classified the patients into active cancer (n = 26) and control groups (n = 227) and compared clinical data. Primary outcome was a modified Rankin scale score at 3 months with ordinal logistic regression (shift analysis).

Results

Initial National Institutes of Health Stroke Scale (NIHSS) and rate of successful recanalisation did not differ between groups, but the active cancer group showed poor outcomes at 3 months on shift analysis (P = 0.001). The independent predictors of poor prognosis were age [adjusted common odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.01–1.05], baseline NIHSS (aOR 1.14, 95% CI 1.09–1.19), baseline C-reactive protein level (aOR 1.14, 95% CI 1.03–1.25), any cerebral haemorrhage (aOR 1.92, 95% CI 1.21–3.06), and active cancer (aOR 2.35, 95% CI 1.05–5.25). Mortality at 90 days was 30.8% in the cancer group and 8.8% in the control group (P = 0.003).

Conclusions

Although baseline characteristics and recanalisation rate after IAT up to 24 h after stroke onset were similar between acute ischaemic stroke patients with active cancer and without any cancer, stroke-related death and short-term outcome were significantly poorer in patients with active cancer than the controls. Post-procedural haemorrhage and active cancer itself were independent predictors of a decrease in functional independence at 3 months.

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Authors and Affiliations

  1. Department of Neurology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea

    Dongwhane Lee

  2. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Deok Hee Lee & Dae Chul Suh

  3. Department of Neurology, Hanyang University College of Medicine, Seoul, South Korea

    Hyuk Sung Kwon

  4. Department of Neurology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, South Korea

    Da-Eun Jeong

  5. Department of Neurology, Jeju National University Hospital, Jeju, South Korea

    Joong-Goo Kim

  6. Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea

    Ji-Sung Lee

  7. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Jong S. Kim, Dong-Wha Kang, Sang-Beom Jeon, Eun-Jae Lee, Kyung Chul Noh & Sun U. Kwon

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  1. Dongwhane Lee
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Corresponding author

Correspondence to Sun U. Kwon.

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This study was approved by Asan Medical Center institutional review board.

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Lee, D., Lee, D.H., Suh, D.C. et al. Intra-arterial thrombectomy for acute ischaemic stroke patients with active cancer. J Neurol 266, 2286–2293 (2019). https://doi.org/10.1007/s00415-019-09416-8

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  • DOI: https://doi.org/10.1007/s00415-019-09416-8

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