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Original research
Endovascular thrombectomy for acute ischemic stroke in patients with cancer: a propensity-matched analysis
  1. Krishna C Joshi1,
  2. Parneet Grewal2,
  3. André Beer-Furlan1,
  4. Alejandro Vargas3,
  5. Nicholas Osteraas3,
  6. Rima Dafer3,
  7. Michael Chen3
  1. 1Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
  2. 2Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Krishna C Joshi, Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, USA; Krishna_C_Joshi{at}rush.edu

Abstract

Background There is a paucity of data and a belief that endovascular thrombectomy (EVT) has low efficacy for acute ischemic stroke (AIS) in patients with cancer. We aimed to critically compare the clinical outcomes of EVT for AIS in patients with and without cancer.

Methods Records of all patients undergoing EVT for AIS between January 2015 and 2020 were screened for cancer at the time of EVT. Active cancer was defined as patients who were diagnosed with cancer and were undergoing or refused treatment for that cancer. Baseline modified Rankin Scale (mRS), age and sex were used in a 1:5 propensity score matching ratio. After matching we evaluated for any change in the National Institutes of Health Stroke Scale (NIHSS) from baseline to discharge, hemorrhagic transformation (HT), and 90-day mRS and mortality.

Results There were 19 patients with cancer and 95 matched controls. The mean±SD age was 70.89±11.16 years, and 17 (89.47%) were female. The baseline NIHSS was 22±7.5 and baseline mRS was 1 (IQR 1). There was no significant difference in change in baseline to discharge NIHSS, 90-day mRS or mortality; 90-day mRS 0–2 was 45.2% in the non-cancer group versus 46.7% in cancer group (p=0.54). HT was significantly higher in patients with cancer (57.89% vs 6.49%, p<0.001).

Conclusions In propensity matched analysis of patients undergoing EVT for AIS with and without cancer, 90-day functional outcomes and mortality were similar. However, there was a significantly higher rate of HT in cancer patients.

  • stroke
  • thrombectomy
  • tumor
  • malignant

Data availability statement

Data are available upon reasonable request. Data is available and will be shared upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Data is available and will be shared upon reasonable request.

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  • Contributors KCJ, PG and AB-F were involved in conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND drafting the work or revising it critically for important intellectual content; AND Final approval of the version to be published. AV, NO and RD were involved in drafting the work or revising it critically for important intellectual content; AND final approval of the version to be published. MC made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND drafting the work or revising it critically for important intellectual content; AND final approval of the version to be published. KJ, PG and MC are guarantors of the overall content. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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.

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