Intra-arterial thrombectomy for acute ischaemic stroke patients with active cancer

Abstract

Background and purpose This study aimed to evaluate the efficacy of intra-arterial thrombectomy (IAT) and prognosis for acute ischaemic stroke patients with active cancer. Methods We retrospectively reviewed 253 patients who underwent IAT within 24 h after stroke onset between January 2012 and August 2017. We classified the patients into active cancer (n = 26) and control groups (n = 227) and compared clinical data. Primary outcome was a modified Rankin scale score at 3 months with ordinal logistic regression (shift analysis). Results Initial National Institutes of Health Stroke Scale (NIHSS) and rate of successful recanalisation did not differ between groups, but the active cancer group showed poor outcomes at 3 months on shift analysis (P = 0.001). The independent predictors of poor prognosis were age [adjusted common odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.01-1.05], baseline NIHSS (aOR 1.14, 95% CI 1.09-1.19), baseline C-reactive protein level (aOR 1.14, 95% CI 1.03-1.25), any cerebral haemorrhage (aOR 1.92, 95% CI 1.21-3.06), and active cancer (aOR 2.35, 95% CI 1.05-5.25). Mortality at 90 days was 30.8% in the cancer group and 8.8% in the control group (P = 0.003). Conclusions Although baseline characteristics and recanalisation rate after IAT up to 24 h after stroke onset were similar between acute ischaemic stroke patients with active cancer and without any cancer, stroke-related death and short-term outcome were significantly poorer in patients with active cancer than the controls. Post-procedural haemorrhage and active cancer itself were independent predictors of a decrease in functional independence at 3 months.