机械血栓切除术治疗癌症患者急性缺血性卒中的疗效：单中心经验与 Meta 分析。

IF 2.3 Q3 CLINICAL NEUROLOGY

Neurology. Clinical practice Pub Date : 2024-10-01 Epub Date: 2024-06-10 DOI:10.1212/CPJ.0000000000200320

Mohamed N Elmarawany, Islam El Malky, Sebastian Winklhofer, Mira Katan, Souvik Kar, Gerasimos Baltsavias

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引用次数: 0

摘要

背景和目的：已发表的有关癌症患者机械血栓切除术（MT）的数据很少。我们介绍了本机构在这种临床情况下的经验，以及一项荟萃分析：方法：我们对三组中风患者（对照组、活动性恶性肿瘤患者（AM）和有恶性肿瘤病史的患者（HOM））的基线数据、手术数据、MT 的临床和放射学结果进行了分析和比较。对 12 项研究进行了荟萃分析，以探讨对照组和 AM 患者在选定结果方面的差异：3组患者（对照组、AM组、HOM组）在中风或TIA既往史（7.8% vs 10.5% vs 38.5%，P = 0.006）、饮酒（0.9% vs 10.5% vs 0.0%，P = 0.04）、血栓性疾病（1.7% vs 15.8% vs 7.7%，P = 0.009）、深静脉血栓形成（0.4 vs 26.3% vs 7.7%，P = 0.005）方面存在显著差异。AM 组的 sICH 发生率（3.5% [对照组] vs 21.1% [AM] vs 0.0% [HOM]，P = 0.007）和 3 个月的死亡率（27.5% [对照组] vs 61.5% [AM] vs 40.0% [HOM] vs，P = 0.032）均明显高于对照组。对照组和 HOM 组在 3 个月后的功能独立性明显更好（52.1% [对照组] vs 15.4% [AM] vs 60.0% [HOM]，P = 0.032）。在荟萃分析中，AM 组在住院期间的死亡率明显更高（n = 6，OR 95% CI = 3.在荟萃分析中，AM 组住院期间（n = 6，OR 95% CI = 3. 03 [1.62, 5.64]）和 3 个月时的死亡率明显更高（n = 10，OR 95% CI = 4.33 [2.80, 6.68]），3 个月功能独立率（mRS = 0-2）明显更低（n = 10，OR 95% CI = 0.47 [0.32, 0.70]）。在 sICH 发生率方面没有发现明显差异（n = 6，汇总 OR 95% CI = 2.03 [0.83, 4.95]）：讨论：血管内MT在治疗活动性恶性肿瘤患者LVO引起的AIS方面技术上是成功的，也是相当安全的。然而，sICH 的原因和影响还需要进一步研究。尽管技术上取得了成功，但这些患者的临床预后不佳，而且 MT 的长期益处仍不确定。

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Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke in Cancer Patients: A Single-Center Experience and Meta-Analysis.

Background and objectives: The published data about mechanical thrombectomy (MT) in cancer patients is sparse. We present our institutional experience in this clinical scenario, and a meta-analysis.

Methods: The baseline data, procedural data, clinical and radiological outcomes of MT were analyzed and compared among three groups of stroke patients: controls, patients with active malignancy (AM), and patients with history of malignancy (HOM). A meta-analysis of 12 studies was conducted to address the differences between controls and AM patients regarding selected outcomes.

Results: The 3 groups (controls, AM, HOM) showed significant differences regarding previous history of stroke or TIA (7.8% vs 10.5% vs 38.5%, p = 0.006), alcohol consumption (0.9% vs 10.5% vs 0.0%, p = 0.04), thrombophilia (1.7% vs 15.8% vs 7.7%, p = 0.009), deep venous thrombosis (0.4 vs 26.3% vs 7.7%, p = 0.005). The AM group had significantly higher rates of sICH (3.5% [controls] vs 21.1% [AM] vs 0.0% [HOM], p = 0.007), and mortality at 3 months (27.5% [controls] vs 61.5% [AM] vs 40.0% [HOM] vs, p = 0.032). The control and HOM groups had significantly better functional independence at 3 months (52.1% [controls] vs 15.4% [AM] vs 60.0% [HOM], p = 0.032).In the meta-analysis, the AM arm showed significantly higher mortality during hospitalization (n = 6, OR 95% CI = 3.03 [1.62, 5.64]), and at 3 months (n = 10, OR 95% CI = 4.33 [2.80, 6.68]), and significantly lower rates of 3 months functional independence (mRS = 0-2) (n = 10, OR 95% CI = 0.47 [0.32, 0.70]). No significant difference was found in sICH rates (n = 6, pooled OR 95% CI = 2.03 [0.83, 4.95]).

Discussion: Endovascular MT is technically successful and reasonably safe in treating AIS from LVO in active malignancy patients. However, the causes and implications of sICH require further investigation. Despite technical success, these patients experience poor clinical outcomes, and the long-term benefits of MT remain uncertain.

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来源期刊

Neurology. Clinical practice CLINICAL NEUROLOGY-

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4.00

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0.00%

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期刊介绍： Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.