Abstract
Background and Objectives To explore clinical and safety outcomes of patients with acute ischemic stroke (AIS) and active cancer after endovascular treatment (EVT). Methods Using data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry, we compared patients with active cancer (defined as cancer diagnosed within 12 months before stroke, metastatic disease, or current cancer treatment) to patients without cancer. Outcomes were 90-day modified Rankin Scale (mRS) score, mortality, successful reperfusion (expanded Treatment in Cerebral Infarction score ≥2b), symptomatic intracranial hemorrhage (sICH), and recurrent stroke. Subgroup analyses were performed in patients with a prestroke mRS score of 0 or 1 and according to treatment setting (curative or palliative). Analyses were adjusted for prognostic variables. Results Of 2,583 patients who underwent EVT, 124 (4.8%) had active cancer. They more often had prestroke disability (mRS score ≥2: 34.1% vs 16.6%). The treatment setting was palliative in 25.3% of the patients. There was a shift toward worse functional outcome at 90 days in patients with active cancer (adjusted common odds ratio [acOR] 2.2, 95% confidence interval [CI] 1.5–3.2). At 90 days, patients with active cancer were less often independent (mRS score 0–2: 22.6% vs 42.0%, adjusted OR [aOR] 0.5, 95% CI 0.3–0.8) and more often dead (52.2% vs 26.5%, aOR 3.2, 95% CI 2.1–4.9). Successful reperfusion (67.8% vs 60.5%, aOR 1.4, 95% CI 1.0–2.1) and sICH rates (6.5% vs 5.9%, aOR 1.1, 95% CI 0.5–2.3) did not differ. Recurrent stroke within 90 days was more common in patients with active cancer (4.0% vs 1.3%, aOR 3.1, 95% CI 1.2–8.1). The sensitivity analysis of patients with a prestroke mRS score of 0 or 1 showed that patients with active cancer still had a worse outcome at 90 days (acOR 1.9, 95% CI 1.2–3.0). Patients with active cancer in a palliative treatment setting regained functional independence less often compared to patients in a curative setting (18.2% vs 32.1%), and mortality was higher (81.8% vs 39.3%). Discussion Despite similar technical success, patients with active cancer had significantly worse outcomes after EVT for AIS. Moreover, they had an increased risk of recurrent stroke. Nevertheless, about a quarter of the patients regained functional independence, and the risk of other complications, most notably sICH, was not increased.
| Original language | English |
|---|---|
| Pages (from-to) | E993-E1001 |
| Journal | Neurology |
| Volume | 98 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 8 Mar 2022 |
Bibliographical note
Funding Information:The MR CLEAN Registry was funded and carried out by Erasmus MC University Medical Center, Amsterdam UMC, and Maastricht University Medical Center. The MR CLEAN Registry was additionally funded by the TWIN Foundation.
Funding Information:
B.J. Emmer reports funding from ZonMW (Leading the Change) and Health Holland paid to institution and has received grants paid to institution from Stryker Neurovascular in the past and personal fees from Dekra and from Novartis outside the submitted work in the past. C.B.L.M. Majoie reports grants from CVON/Dutch Heart Foundation, European Commission, TWIN Foundation, Stryker, and Health Evaluation Netherlands, all outside the submitted work (paid to institution), and is shareholder of Nico. lab, a company that focuses on the use of artificial intelligence for medical image analysis. Y.B.W.E.M. Roos is a minor shareholder of Nico. lab. H.B. van der Worp has received speaker's fees Boehringer Ingelheim, has served as a consultant to Boehringer Ingelheim, and is the recipient of unrestricted grants from Dutch Heart Foundation and the European Union for the conduct of trials on acute treatment for stroke, all outside the submitted work. D.W.J. Dippel reports fees for consultations by Stryker and Bracco Imaging; grants from Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, The Netherlands Organisation for Health Research and Development, and Health Holland Top Sector Life Sciences & Health; and unrestricted grants from AngioCare BV, Covidien/EV3, MEDAC Gmbh/LAMEPRO, Top Medical/Concentric, Stryker, Stryker European Operations BV, Penumbra Inc, Medtronic, Thrombolytic Science, LLC, and Cerenovus, all paid to institution. J.M. Coutinho received unrelated research support from the Dutch Heart Foundation, Bayer, Boehringer, and Medtronic. All fees were paid to his employer. All other authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Publisher Copyright:
Copyright © 2022 American Academy of Neurology.
