Endovascular treatment in ischemic stroke with active cancer: retrospective analysis of university stroke center data.

Q2 Medicine
Athina-Maria Aloizou, David-Dimitrios Chlorogiannis, Daniel Richter, Theodoros Mavridis, Dimitra Aloizou, Carsten Lukas, Ralf Gold, Christos Krogias
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Abstract

Introduction: Active cancer (AC) associates strongly with ischemic stroke (IS). Intravenous thrombolysis (IVT) is often contraindicated in AC, and endovascular treatment (EVT) is considered the gold treatment standard, although data on its safety and efficacy is scarce.

Methods: Digital records of patients receiving EVT in a tertiary university hospital with comprehensive stroke center from 2016 to 2022 were assessed. Demographic, clinical, and laboratory parameters were extracted and compared between patients with and without AC. In-hospital mortality was set as the primary outcome.

Results: 39 AC and 297 non-AC patients were included. No significant differences were reported in demographic and baseline stroke parameters (NIHSS, mRS, stroke etiology). In-hospital mortality did not differ between groups (11/39 vs. 57/297, p > 0.99). Successful recanalization, change in mRS and NIHSS from admission to discharge, periinterventional complications, and stroke-related mortality were also comparable. Significantly fewer AC patients received IVT. In the binary logistic regression analysis (adjusting for confounder variables), older age, large artery atherosclerosis, unsuccessful recanalization, and higher admission NIHSS were independent predictors of all-cause in-hospital mortality (aOR): 1.04, 95% confidence interval (CI): 1.01-1.08; OR: 3.21, 95% CI: 1.03-9.92, OR: 7.28, 95% CI: 3.61-15.1, OR: 1.07, 95% CI: 1.01-1.14, p-value < 0.05, respectively).

Conclusions: EVT was shown as safe and effective in AC patients as in non-AC patients. Long-term functional outcomes are often poorer in AC, due to the cancer itself, but given how oncological treatment depends on functional status, AC patients should be considered for EVT.

血管内治疗伴有活动性肿瘤的缺血性脑卒中:大学脑卒中中心资料的回顾性分析。
活动性癌症(AC)与缺血性脑卒中(IS)密切相关。静脉溶栓(IVT)通常是AC的禁忌症,血管内治疗(EVT)被认为是金治疗标准,尽管关于其安全性和有效性的数据很少。方法:对某三级大学附属综合脑卒中中心医院2016 - 2022年EVT患者的数字记录进行评估。提取人口学、临床和实验室参数,并对有无AC患者进行比较。将住院死亡率设置为主要终点。结果:共纳入39例AC患者和297例非AC患者。人口学和基线卒中参数(NIHSS、mRS、卒中病因)无显著差异。住院死亡率组间无差异(11/39 vs. 57/297, p < 0.99)。再通成功、入院至出院期间mRS和NIHSS的变化、介入期并发症和卒中相关死亡率也具有可比性。AC患者接受IVT的明显减少。在二元logistic回归分析(调整混杂变量)中,年龄较大、大动脉粥样硬化、再通失败和入院时较高的NIHSS是院内全因死亡率(aOR)的独立预测因子:1.04,95%可信区间(CI): 1.01-1.08;OR: 3.21, 95% CI: 1.03-9.92, OR: 7.28, 95% CI: 3.61-15.1, OR: 1.07, 95% CI: 1.01-1.14, p值结论:EVT在AC患者中与非AC患者一样安全有效。由于癌症本身的原因,AC的长期功能预后通常较差,但考虑到肿瘤治疗取决于功能状态,AC患者应考虑EVT。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.40
自引率
0.00%
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0
审稿时长
14 weeks
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