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Ischemic stroke
Original research
Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis
  1. Hong-Jie Jhou1,2,
  2. Li-Yu Yang1,2,
  3. Po-Huang Chen3,
  4. Cho-Hao Lee4
  1. 1 Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
  2. 2 School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  3. 3 Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  4. 4 Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  1. Correspondence to Mr. Cho-Hao Lee, Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; drleechohao{at}gmail.com; Mr Po-Huang Chen, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; chenpohuang{at}hotmail.com

Abstract

Background Active malignancy has a poorer prognosis and more deaths in patients with acute ischemic stroke (AIS). The outcomes of endovascular therapy (EVT) remain controversial in patients with AIS and active malignancy.

Methods We searched PubMed, Cochrane, and Embase for articles published up to June 1, 2022. The primary outcome was good functional outcome at 3 months and successful reperfusion between patients with cancer and AIS and control patients. The secondary and safety outcomes included mortality at 3 months, in-hospital mortality, symptomatic intracerebral hemorrhage (sICH), any ICH, and subarachnoid hemorrhage (SAH).

Results Twelve studies involving 5944 patients with AIS secondary to EVT were included (389 patients having active malignancy). The OR of good functional outcome at 3 months was 0.53 (95% CI 0.41 to 0.67) between the two groups. The OR of successful reperfusion between the two groups was 0.90 (95% CI 0.63 to 1.30). Compared with patients without cancers, those with cancers had a higher risk of mortality at 3 months (OR 3.64; 95% CI 2.35 to 6.27) and in-hospital mortality (OR 3.46; 95% CI 1.71 to 7.01). Despite a higher point estimate regarding any ICH (OR 1.41; 95% CI 1.01 to 1.96) and SAH (OR 2.53; 95% CI 1.10 to 5.81), sICH (OR 0.85; 95% CI 0.51 to 1.42) was not significant.

Conclusion Although a quarter of patients with active malignancy and AIS regained functional independence, physicians and patients should consider whether to apply EVT in patients with active malignancy.

  • Stroke
  • Neoplasm
  • Intervention

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2022-019489

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @JhouJie, @vicky102433

    • Contributors HJJ and LYY collected data. HJJ designed the study. PHC analyzed the data. HJJ and LYY drafted the manuscript and interpreted data. PHC and CHL critically reviewed and edited the manuscript. All authors have approved the final version to be published and agree to be accountable for all aspects of the work. CHL and PHC are guarantors of the work.

    • Funding This study was supported by the Tri‐Service General Hospital (TSGH‐D‐111157).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.