PT  - JOURNAL ARTICLE
AU  - Jhou, Hong-Jie
AU  - Yang, Li-Yu
AU  - Chen, Po-Huang
AU  - Lee, Cho-Hao
TI  - Endovascular therapy for acute ischemic stroke in patients with active malignancy: a meta-analysis with trial sequential analysis
AID  - 10.1136/jnis-2022-019489
DP  - 2023 Sep 01
TA  - Journal of NeuroInterventional Surgery
PG  - e154--e160
VI  - 15
IP  - e1
4099  - http://jnis.bmj.com/content/15/e1/e154.short
4100  - http://jnis.bmj.com/content/15/e1/e154.full
SO  - J NeuroIntervent Surg2023 Sep 01; 15
AB  - 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.Data are available upon reasonable request.