Mechanical Thrombectomy for Acute Ischemic Stroke in Metastatic Cancer Patients: A Nationwide Cross-Sectional Analysis
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Background and Purpose Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials. Methods We searched the National Readmission Database for LVO patients treated with MT between 2016–2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders. Results Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P<0.001). Patients with MC had similar rates of intracerebral hemorrhage (20% vs. 21%) but were less likely to receive tissue plasminogen activator (13% vs. 23%, P<0.001). In unadjusted analysis, MC patients as compared to cancer-free patients had a higher in-hospital mortality rate and were less likely to be discharged to home (36% vs. 42%, P=0.014). On multivariate regression adjusting for confounders, mortality was the only outcome that was significantly higher in the MC group than in the cancerfree group (P<0.001). Conclusion LVO patients with MC have higher mortality and more infectious and thrombotic complications than cancer-free patients. MT nonetheless can result in survival with good outcome in slightly over one-third of patients.
Abstract
Background and Purpose Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials. Methods We searched the National Readmission Database for LVO patients treated with MT between 2016–2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders. Results Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P<0.001). Patients with MC had similar rates of intracerebral hemorrhage (20% vs. 21%) but were less likely to receive tissue plasminogen activator (13% vs. 23%, P<0.001). In unadjusted analysis, MC patients as compared to cancer-free patients had a higher in-hospital mortality rate and were less likely to be discharged to home (36% vs. 42%, P=0.014). On multivariate regression adjusting for confounders, mortality was the only outcome that was significantly higher in the MC group than in the cancerfree group (P<0.001). Conclusion LVO patients with MC have higher mortality and more infectious and thrombotic complications than cancer-free patients. MT nonetheless can result in survival with good outcome in slightly over one-third of patients.
참고문헌 (31)
- Graus F, "Cerebrovascular complications in patients with cancer", Medicine(Baltimore), 64, pp.16~35 (1985)
- Casado-Naranjo I, "Intravenous thrombolysis for acute stroke in patients with cancer", J Neurol Neurosurg Psychiatry, 82, pp.1404~1405 (2011)
- Verschoof MA, "Clinical outcome after endovascular treatment in patients with active cancer and ischemic stroke : a MR CLEAN registry substudy", Neurology, 98, pp.e993~e1001 (2022)
- Jovin TG, "Thrombectomy within 8 hours after symptom onset in ischemic stroke", N Engl J Med, 372, pp.2296~2306 (2015)
- Campbell BC, "Endovascular therapy for ischemic stroke with perfusion-imaging selection", N Engl J Med, 372, pp.1009~1018 (2015)
- Goyal M, "Randomized assessment of rapid endovascular treatment of ischemic stroke", N Engl J Med, 372, pp.1019~1030 (2015)
- Saver JL, "Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke", N Engl J Med, 372, pp.2285~2295 (2015)
- Berkhemer OA, "A randomized trial of intraarterial treatment for acute ischemic stroke", N Engl J Med, 372, pp.11~20 (2015)
- Lee D, "Intra-arterial thrombectomy for acute ischaemic stroke patients with active cancer", J Neurol, 266, pp.2286~2293 (2019)
- Jung S, "Procedural and clinical outcomes of endovascular recanalization therapy in patients with cancer-related stroke", Interv Neuroradiol, 24, pp.520~528 (2018)
- Cho BH, "Outcomes of endovascular treatment in acute ischemic stroke patients with current malignancy", Neurol Sci, 41, pp.379~385 (2020)
- Sallustio F, "Safety and efficacy of reperfusion therapies for acute ischemic stroke patients with active malignancy", J Stroke Cerebrovasc Dis, 28, pp.2287~2291 (2019)
- "Healthcare Cost and Utilization Project (HCUP)" (2022)[URL]
- Henderson T, "Quality of diagnosis and procedure coding in ICD-10 administrative data", Med Care, 44, pp.1011~1019 (2006)
- "All Patient Refined Diagnosis Related Groups (APR-DRGs): version 20.0. Methodology overview" (2003)[URL]
- Dicpinigaitis AJ, "Endovascular thrombectomy for treatment of acute ischemic stroke during pregnancy and the early postpartum period", Stroke, 52, pp.3796~3804 (2021)
- Motataianu A, "Ischemic stroke in patients with cancer : a retrospective cross-sectional study", J Crit Care Med(Targu Mures), 7, pp.54~61 (2021)
- Navi BB, "Ischemic stroke in cancer patients : a review of an underappreciated pathology", Ann Neurol, 83, pp.873~883 (2018)
- Grisold W, "Stroke and cancer : a review", Acta Neurol Scand, 119, pp.1~16 (2009)
- Rickles FR, "Activation of blood coagulation in cancer : Trousseau’s syndrome revisited", Blood, 62, pp.14~31 (1983)
- Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment", Stroke, 24, pp.35~41 (1993)
- Kim SG, "Ischemic stroke in cancer patients with and without conventional mechanisms : a multicenter study in Korea", Stroke, 41, pp.798~801 (2010)
- Murthy SB, "Thrombolysis for acute ischemic stroke in patients with cancer : a population study", Stroke, 44, pp.3573~3576 (2013)
- Khorana AA, "Thromboembolism in hospitalized neutropenic cancer patients", J Clin Oncol, 24, pp.484~490 (2006)
- Selvik HA, "Intravenous thrombolysis in ischemic stroke patients with active cancer", Front Neurol, 9, pp.811~ (2018)
- Lee EJ, "Effectiveness of mechanical thrombectomy in cancer-related stroke and associated factors with unfavorable outcome", BMC Neurol, 21, pp.57~ (2021)
- Yoo J, "Immediate and long-term outcomes of reperfusion therapy in patients with cancer", Stroke, 52, pp.2026~2034 (2021)
- Ciolli L, "Efficacy of mechanical thrombectomy in patients with ischemic stroke and cancer", J Clin Neurosci, 91, pp.20~22 (2021)
- Joshi KC, "Endovascular thrombectomy for acute ischemic stroke in patients with cancer : a propensity-matched analysis", J Neurointerv Surg, 14, pp.1161~1165 (2022)
- Oki S, "Long-term clinical outcome and prognosis after thrombectomy in patients with concomitant malignancy", Front Neurol, 11, pp.572589~ (2020)
- Ren C, "Effect of conscious sedation vs. general anesthesia on outcomes in patients undergoing mechanical thrombectomy for acute ischemic stroke:a prospective randomized clinical trial", Front Neurol, 11, pp.170~ (2020)