Mattingly Thomas K, Risco Jorge E, Burch Jaclyn E, Whyte Raquel, Kohli Gurkirat S, Susa Stephen, Bhalla Tarun, Bender Matthew T
Dept of Neurosurgery, University of Rochester, Rochester, NY. 585-273-1900, United States.
Dept of Neurology, University of Rochester, Rochester, NY. 585-275-2776, United States.
J Stroke Cerebrovasc Dis. 2022 Jun;31(6):106439. doi: 10.1016/j.jstrokecerebrovasdis.2022.106439. Epub 2022 Mar 18.
Ischemic stroke and concurrent cancer is increasingly recognized. However, optimal management is uncertain. As mechanical thrombectomy has become the standard of care for large vessel occlusion, more patients with cancer are presenting for embolectomy. However, it is unknown whether this subgroup has the same benefit profile described in multiple randomized trials for thrombectomy for large vessel occlusion. Our objective was to retrospectively evaluate a North American embolectomy database for safety and outcomes in patients with active cancer.
A case series of 284 embolectomies over 30 months at a single North American stroke center were divided into thrombectomy patients with active cancer(n=25) and those without active cancer (n=259). We compared patient characteristics, procedural characteristics, and procedural outcomes between patients with and without active cancer. Univariate and multivariate analysis of angiographic outcomes, postoperative hemorrhage, and functional outcome was performed.
Of the 284 thrombectomy cases, 9% were performed on patients with active cancer. Active cancer patients had a similar recanalization grade and post-operative hemorrhage rate, compared to patients without cancer. Active cancer patients had a significantly higher 90 day mortality (40% vs 20%, p=0.018). On multivariate analysis, good functional outcome (mRS 0-2) was not impacted by active cancer. However, when mRS was evaluated as an ordinal shift analysis, worse functional outcome was associated with active cancer (OR 2.98; 95% CI, 1.29 to 6.59), greater age, NIHSS> 10, and ASPECTS<9.
This single center retrospective series of active cancer patients undergoing thrombectomy for large vessel occlusion demonstrates similar rates of recanalization, post-operative hemorrhage, and good outcomes. While the active cancer group has a high short-term mortality, the potential to maintain quality of life in the survivors makes thrombectomy reasonable in this patient population. Awareness of ischemic stroke as a complication of cancer and the safety of thrombectomy in this population are important as this population subtype is expected to grow with improved oncology and stroke care.
缺血性卒中与并发癌症越来越受到关注。然而，最佳治疗方案尚不确定。由于机械取栓已成为大血管闭塞的标准治疗方法，越来越多的癌症患者前来接受取栓手术。然而，该亚组患者是否具有多项大血管闭塞取栓随机试验中描述的相同获益情况尚不清楚。我们的目的是回顾性评估北美一个取栓数据库中患有活动性癌症患者的安全性和预后。
在北美一个单一的卒中中心，对30个月内进行的284例取栓手术病例进行了系列研究，将其分为患有活动性癌症的取栓患者（n = 25）和无活动性癌症的患者（n = 259）。我们比较了有和没有活动性癌症患者的患者特征、手术特征和手术结果。对血管造影结果、术后出血和功能结局进行了单因素和多因素分析。
在284例取栓病例中，9%是对患有活动性癌症的患者进行的。与无癌症患者相比，患有活动性癌症的患者再通等级和术后出血率相似。患有活动性癌症的患者90天死亡率显著更高（40%对20%，p = 0.018）。在多因素分析中，良好的功能结局（改良Rankin量表评分0 - 2）不受活动性癌症影响。然而，当将改良Rankin量表评分作为有序移位分析进行评估时，较差的功能结局与活动性癌症相关（比值比2.98；95%置信区间，1.29至6.59）、年龄较大、美国国立卫生研究院卒中量表评分> 10以及脑梗死溶栓治疗安全实施量表评分< 9。
这个单中心回顾性系列研究中，患有活动性癌症的患者因大血管闭塞接受取栓手术，其再通率（恢复血流的程度）、术后出血率和良好结局相似。虽然患有活动性癌症的患者短期死亡率较高，但幸存者维持生活质量的可能性使得对该患者群体进行取栓手术是合理的。鉴于随着肿瘤学和卒中治疗的改善，这一患者亚群预计会增加，认识到缺血性卒中作为癌症并发症以及该群体中取栓手术的安全性很重要。
