Endovascular Treatment in Patients With Acute Ischemic Stroke and Comorbid Cancer: Analysis of the Italian Registry of Endovascular Treatment in Acute Stroke
Year: 2022
Type: article
Study design: Observational Study
Abstract: Background Acute stroke patients with comorbid cancer (CC) are more preferably addressed with endovascular treatment (EVT) than thrombolytic therapy, due to the presumed potential risk of hemorrhagic transformation and systemic bleeding. This study aims to evaluate clinical and procedural outcomes of acute stroke patients with CC receiving EVT. Methods Using the Italian Registry of Endovascular Treatment in Acute Stroke, we reviewed prospectively collected data of CC patients treated with EVT from 2011 to 2017. Outcome measures were modified Thrombolysis in Cerebral Infarction score, symptomatic intracranial hemorrhage rate, and 3‐month modified Rankin scale. We also compared CC patients with a control group without cancer (non‐comorbid cancer) receiving EVT and matched the 2 populations with a 1:1 propensity score. Results Out of 4598 stroke patients treated with EVT, 165 (3.6%) had a CC. Modified Thrombolysis in Cerebral Infarction 2b‐3 was obtained in 73.8% of CC and 74.5% of non‐comorbid cancer patients ( P =0.84), whereas the rate of symptomatic intracranial hemorrhage rate was 8.2% and 6.9%, respectively. Three‐month all‐cause mortality was 33.3% in CC patients and 18.6% non‐comorbid cancer patients ( P <0.001), and after propensity score was 35.4% and 22.1%, respectively ( P =0.012). In CC patients, the presence of metastasis and a more recent diagnosis of cancer were significantly associated with a higher 3‐month mortality ( P =0.018 and 0.021, respectively). Breast cancer showed a significant correlation with mild or no disability (odds ratio, 3.32; CI, 1.28–8.67; P =0.014) and less death cases at 3‐months (odds ratio, 0.44; CI, 0.16–1.21; P =0.114) compared to the other most represented malignancies. Conclusion Although 3‐month all‐cause mortality was significantly higher in CC patients, successful recanalization and hemorrhagic transformation rate were comparable in both groups. In cancer patients, a metastatic and active disease seem to be associated with a poorer functional outcome, whereas a diagnosis of breast cancer appears to be more frequent in patients with a mild or no disability at long term.
Authors: Federica Letteri, Giovanni Pracucci, Valentina Saia, Fabrizio Sallustio, Alfredo Paolo Mascolo, Valerio Da Ros, Rossana Tassi, Maurizio Acampa, Sandra Bracco, Alessandro De Vito, Ilaria Casetta, Andrea Saletti, Guido Bigliardi, Stefano Vallone, Marta Iacobucci, Patrizia Nencini, Vanessa Palumbo, Sergio Nappini, Laura Malfatto, Cinzia Finocchi, Lucio Castellan, Simona Sacco, Nicola Giannini, Guido Andrea Lazzarotti, Roberto Cavallo, Chiara Comelli, Adriana Critelli, Nicola Cavasin, Simona Marcheselli, Nunzio Paolo Nuzzi, Mauro Magoni, Roberto Gasparotti, Paolo Invernizzi, Marco Pavia, Angelica Tinelli, Nicola Burdi, Tiziana Tassinari, Riccardo Padolecchia, Marco Petruzzellis, Luigi Chiumarulo, Maria Valeria Saddi, Giovanni Dui, Monia Russo, Pietro Amistà, Andrea Zini, Salvatore Mangiafico, Danilo Toni, “on behalf of the Italian Registry of Endovascular Treatment in Acute Stroke”
Institutions: Azienda Usl Toscana Centro, Sapienza University of Rome, Azienda Ospedaliero-Universitaria Careggi, Ospedale Santa Corona, University of Rome Tor Vergata, Policlinico Tor Vergata, Azienda Ospedaliera Universitaria Senese, University of Ferrara, Arcispedale Sant'Anna, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Ospedale Policlinico San Martino, University of L'Aquila, University of Pisa, Azienda Ospedaliera Universitaria Pisana, Ospedale San Giovanni Bosco, Ospedale dell' Angelo, IRCCS Humanitas Research Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, Fondazione Poliambulanza Istituto Ospedaliero, Ospedale SS. Annunziata, Azienda Sanitaria Locale N. 2 Savonese, University of Bari Aldo Moro, Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari, Ospedale Santa Maria della Misericordia di Rovigo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Ospedale Maggiore Carlo Alberto Pizzardi, Istituto delle Scienze Neurologiche di Bologna
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,300
OpenAlex ID: W4307201124