Identification the Cause of Cerebral Infarction in Patients With Cancer

Study Overview
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Brief Summary
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Although there has been increasing interest in the association between cancer and cerebrovascular disease, the underlying pathophysiology of stroke in cancer patients is still not fully understood. The aim of this study is to investigate the stroke mechanisms in patients with cancer-associated stroke.

Detailed Description
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Patients with cryptogenic embolic stroke will be prospectively enrolled and categorized into two groups according to the presence of active cancer: cryptogenic embolic stroke with active cancer (cancer-associated stroke) vs. without active cancer (cryptogenic embolic stroke). All patients will undergo brain MRI/MRA, 12-lead electrocardiography, transthoracic and transesophageal echocardiography with injection of agitated saline, and 24-hour Holter and/or telemonitoring. Duplex ultrasonography to detect venous thrombosis of the lower extremity will also be performed in patients with a positive right-to-left shunt on echocardiography.

Official Title
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Identification the Cause of Cerebral Infarction in Patients With Cancer

Conditions
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Cryptogenic Embolic Stroke, Active Cancer

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects with acute ischemic stroke who presented within 7 days from symptom onset Subjects who had embolic infarction outside the perforator territory revealed by diffusion-weighted imaging Subjects with undetermined cause of stroke despite of initial evaluation including electrocardiogram and brain imaging upon admission Subjects who performed brain magnetic resonance image (MRI) and MR angiography (MRA), cardiac work-ups (12-lead electrocardiography, transthoracic and/or transesophageal echocardiography with injection of agitated saline (or agitated saline transcranial Doppler monitoring), and 24-hour Holter and/or telemonitoring) Subjects with informed consent Exclusion Criteria: Subjects with single subcortical infarction Subjects with primary brain tumor Inability to perform comprehensive studies Refusal or withdrawal of the consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cancer-associated stroke<br>Cryptogenic embolic stroke with active cancer | |
| Cryptogenic embolic stroke<br>Cryptogenic embolic stroke without active cancer | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of deep vein thrombosis and microembolic signal in cancer related stroke patients | Venous thromboembolism was investigated via Doppler sonography and/or computed tomography pulmonary angiography combined with venous phase CT angiography of the lower extremities. Microembolic signal was detected via transcranial Doppler sonography on symptomatic cerebral circulation | Within one week after enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Impact of intravascular thrombosis on infarct volume | Infarct volume was measured by diffusion-weighted MR imaging and apparent diffusion coefficient calculated from imaging data. Univariate and multivariate linear regression was performed in ESUS patients with cancer (adjusted for age, sex, overt DIC). | Within one week after enrollment | 
| Impact of intravascular thrombosis on survival | Survival time (in years) was measured by subtracting admission date from the date the patient had expired. Cox proportional hazard analysis was used to evaluate association between intravascular thrombosis and survival (adjusted for age, sex, NIHSS, presence of overt DIC, infarct volume, metastasis, and histologic type). | Till the event of death occurs in enrolled patients |