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J Neurol. 2019 Jun 7. doi: 10.1007/s00415-019-09416-8. [Epub ahead of print]

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

Author information

1
Department of Neurology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea.
2
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
3
Department of Neurology, Hanyang University College of Medicine, Seoul, South Korea.
4
Department of Neurology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, South Korea.
5
Department of Neurology, Jeju National University Hospital, Jeju, South Korea.
6
Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea.
7
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
8
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. sunkwon7@gmail.com.

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.

KEYWORDS:

Cancer and stroke; Endovascular recanalisation; Ischaemic stroke; Thrombectomy

PMID:
31175434
DOI:
10.1007/s00415-019-09416-8

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