Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan.
Department of Neurology Tokyo Medical University Hospital Tokyo Japan.
J Am Heart Assoc. 2021 Nov 2;10(21):e021375. doi: 10.1161/JAHA.120.021375. Epub 2021 Oct 23.
Background Cerebrovascular diseases are common comorbidities in patients with cancer. Although active cancer causes ischemic stroke by multiple pathological conditions, including thromboembolism attributable to Trousseau syndrome, the relationship between stroke and inactive cancer is poorly known. The aim of this study was to elucidate the different underlying pathogeneses of cryptogenic stroke in active and inactive patients with cancer, with detailed investigation by transesophageal echocardiography. Methods and Results CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for Embolic Stroke of Undetermined Source/Cryptogenic Stroke) registry is a multicenter registry including data of patients initially diagnosed as having cryptogenic stroke and undergoing transesophageal echocardiography. Patients were divided into active cancer, inactive cancer, and noncancer groups, and their clinical features were compared. Of the total 667 enrolled patients (age, 68.7±12.8 years; 455 men), 41 (6.1%) had active cancer, and 51 (7.5%) had a history of inactive cancer. On multinomial logistic regression analysis, infarctions in multiple vascular territories (odds ratio [OR], 2.73; 95% CI, 1.39-5.40) and CRP (C-reactive protein) (OR, 1.10; 95% CI, 1.01-1.19) were independently associated with active cancer, whereas age (OR, 1.05; 95% CI, 1.01-1.08), contralateral carotid stenosis from the index stroke lesion (OR, 4.05; 95% CI, 1.60-10.27), calcification of the aortic valve (OR, 2.10; 95% CI, 1.09-4.05), and complicated lesion of the aortic arch (OR, 2.13; 95% CI, 1.11-4.10) were significantly associated with inactive cancer. Conclusions Patients with cancer were not rare in cryptogenic stroke. Although patients with active cancer had more multiple infarctions, patients with inactive cancer had more atherosclerotic embolic sources potentially causing arteriogenic strokes. Registration URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000032957.
脑血管疾病是癌症患者常见的合并症。虽然活动期癌症通过包括特鲁索氏症（Trousseau syndrome）引起的血栓栓塞等多种病理情况导致缺血性卒中，但卒中与非活动期癌症之间的关系尚不清楚。本研究旨在通过经食管超声心动图详细研究，阐明活动期和非活动期癌症患者隐源性卒中不同的潜在发病机制。
CHALLENGE ESUS/CS（通过经食管超声心动图明确不明来源栓塞性卒中/隐源性卒中的栓塞性卒中的发病机制）登记研究纳入了最初诊断为隐源性卒中并接受经食管超声心动图检查的患者数据。患者分为活动期癌症、非活动期癌症和非癌症组，并比较了他们的临床特征。在总共 667 名入组患者（年龄 68.7±12.8 岁；455 名男性）中，41 名（6.1%）患有活动期癌症，51 名（7.5%）有非活动期癌症史。在多项逻辑回归分析中，多发病灶梗死（比值比 [OR]，2.73；95%可信区间 [CI]，1.39-5.40）和 C 反应蛋白（OR，1.10；95%CI，1.01-1.19）与活动期癌症独立相关，而年龄（OR，1.05；95%CI，1.01-1.08）、与索引卒中病灶相反侧颈动脉狭窄（OR，4.05；95%CI，1.60-10.27）、主动脉瓣钙化（OR，2.10；95%CI，1.09-4.05）和主动脉弓复杂病变（OR，2.13；95%CI，1.11-4.10）与非活动期癌症显著相关。
癌症患者在隐源性卒中中并不少见。虽然活动期癌症患者多发性梗死更多，但非活动期癌症患者更可能有潜在的动脉源性栓塞源引起的动脉性卒中。
