Concurrent Use of Contact Aspiration and a Stent Retriever Is Associated With Successful Recanalization in Patients With Cancer-Associated Stroke

Abstract

Background and Purpose The optimal thrombectomy technique in emergent large vessel occlusion due to cancer-associated coagulopathy remains uncertain. We aimed to investigate the efficacy and safety of concurrent contact aspiration and stent retriever in this stroke subtype. Methods We retrospectively analyzed consecutive ischemic stroke patients who had undergone endovascular thrombectomy. Patients were characterized as having cancer-associated stroke (CAS) or non-cancer-associated stroke (non-CAS). Thrombectomy technique was classified as a single strategy (either contact aspiration or a stent retriever) or a combined technique (concurrent use of contact aspiration and a stent retriever at least once). Successful recanalization was defined as a modified TICI grade 2b or 3 at the end of the procedure. Factors associated with successful recanalization were analyzed. Results The present study enrolled 393 patients. Of these patients, 56 (14.2%) were found to have cancer-associated stroke. Rates of recanalization (69.6% vs. 91.7%, p<0.001) and 3-month good clinical outcomes (25.5% vs. 42.0%, p=0.025) were significantly lower in patients with CAS than non-CAS, respectively. Although the combined technique was not associated with successful recanalization in the entire cohort, the combined technique was associated with successful recanalization in patients with CAS (odds ratio 6.256, 95% confidence interval, 1.224–31.970; p=0.028). The interaction term between the combined technique and the stroke subtype (CAS vs. non-CAS) was independently associated with successful recanalization (p=0.029). Conclusions The combined technique was associated with successful recanalization in patients with cancer-associated stroke and emergent large vessel occlusion.