Endovascular Treatment in Patients With Acute Ischemic Stroke and Comorbid Cancer: Analysis of the Italian Registry of Endovascular Treatment in Acute Stroke
Authors: Letteri Federica , Pracucci Giovanni , Saia Valentina , Sallustio Fabrizio , Mascolo Alfredo Paolo , Da Ros Valerio , Tassi Rossana , Acampa Maurizio , Bracco Sandra , De Vito Alessandro , Casetta Ilaria , Saletti Andrea , Bigliardi Guido , Vallone Stefano , Iacobucci Marta , Nencini Patrizia , Palumbo Vanessa , Nappini Sergio , Malfatto Laura , Finocchi Cinzia , Castellan Lucio , Sacco Simona , Giannini Nicola , Lazzarotti Guido Andrea , Cavallo Roberto , Comelli Chiara , Critelli Adriana , Cavasin Nicola , Marcheselli Simona , Nuzzi Nunzio Paolo , Magoni Mauro , Gasparotti Roberto , Invernizzi Paolo , Pavia Marco , Tinelli Angelica , Burdi Nicola , Tassinari Tiziana , Padolecchia Riccardo , Petruzzellis Marco , Chiumarulo Luigi , Saddi Maria Valeria , Dui Giovanni , Russo Monia , Amistà Pietro , Zini Andrea , Mangiafico Salvatore , Toni Danilo ,   “on behalf of the Italian Registry of Endovascular Treatment in Acute Stroke”
Published: October 2022

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.