Thrombectomy in Patients With Active Malignancy

HomeStroke: Vascular and Interventional NeurologyVol. 3, No. 3Thrombectomy in Patients With Active Malignancy Open AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toOpen AccessEditorialPDF/EPUBThrombectomy James E. Siegler Thanh N. Nguyen SieglerJames *Correspondence to: Siegler, MD, Cooper Neurological Institute, University Hospital, Camden, NJ 08103. Email: E-mail Address: [email protected]Thanh Nguyen, Department of Neurology, Radiology, Boston Medical Center, Chobanian Avedisian School Medicine, Boston, MA 02118. protected] https://orcid.org/0000-0003-0287-3967 , NJ, Rowan University, Search for more papers by this author NguyenThanh https://orcid.org/0000-0002-2810-1685 MA, Originally published2 May 2023https://doi.org/10.1161/SVIN.123.000835Stroke: Neurology. 2023;3:e000835Patients with stroke comorbid cancer represent a unique population at heightened risk stroke.1 Several direct indirect associations likely account risk, including older age individuals versus without cancer, concomitant factors associated certain cancers (eg, prior tobacco use), use specific chemotherapeutics (which may be prothrombotic), radiation (leading large‐artery vasculopathy or cerebral microvascular injury), predisposition infection as consequence immunosuppression, which can contribute thrombosis. Furthermore, the itself lead relative state hypercoagulability. For these reasons, between 1% 15% patients will experience cerebrovascular event (stroke intracranial hemorrhage).2, 3 These neurological complications not only impair quality life but also disability preclude ongoing additional disease‐modifying oncological care. Unfortunately, many are excluded from short‐term interventional trials stroke; therefore, benefit emergent reperfusion is less well established population. That said, there no biological plausibility why endovascular treatment futile appropriately selected attributable large‐vessel occlusion (LVO) cancer. A term that has developed place “futile reperfusion” “reperfusion functional independence” still have life.4Using real‐world data prospective Italian Registry Endovascular Treatment Acute Stroke (IRETAS), >4500 patients, Letteri et al summarize their thrombectomy who Propensity‐score matching was used reduce confounding indication.5 Across total cohort, investigators reported difference technical success (Thrombolysis Cerebral Infarction scores 2b–3 74% 75%; P=0.84), nor rate symptomatic intracerebral hemorrhage (8% 7%; P=0.53). Rates were similar propensity‐matched cohort (71% 73% 4% 7%, respectively).After propensity‐score (n=152 noncancer groups), probability achieving independence months (modified Rankin Scale score 0–2) high different those (39% 38%; P=0.91). rates comparable another registry (SVIN [Society Neurology] Registry, modified 0–2, 37%)6 randomized trial Highly Effective Reperfusion Evaluated Multiple Trials (HERMES) collaboration (46%; P=0.12 [immediate test proportions]).7In addition demonstrating outcomes population, growing body epidemiologic literature cancer‐associated stroke. Among nested 130 timing diagnosis, nearly two‐thirds (62%) experienced incident LVO >2 years following diagnosis Compared an acute within 1 year 2 years, 3‐month mortality least among after (25% if 45% 50% 1–2 years; P=0.02). Although 25% higher than what been HERMES meta‐analysis anterior circulation (15%),7 remained alive half survivors achieved independence.Currently, societal guidelines recommend select according criteria set forth published clinical trials,8, 9 often On basis available evidence support trial‐ineligible populations,10, 11, 12, 13 equipoise randomizing medical management. Therefore, anticipated put question rest, intervention current rigidly followed.14 In on hospice pathway widely metastatic disease, ethical one should treat best addressed individual patient's family, based resources. Certainly, some severe immediate harboring malignant prognosis, provide any meaningful improvement function. It prolong survival greater disability, end‐of‐life care costs, emotional distress caregivers next kin. detected early, responsive, improve chances recovery sufficient patient tolerate treatment. reflect observational nonrandomized allocation, generally favorable large argue strongly decision proceed must take into consideration premorbid good recovery, overall goals minimal prestroke reasonable (or without) underlying yield better when compared management alone.Sources FundingNone.DisclosuresDr reports advisory board Idorsia.AcknowledgmentsNone.Footnotes*Correspondence Siegler.[email protected]comThanh Thanh.[email protected]orgThe opinions expressed article necessarily editors, American Heart Association, Society Neurology.REFERENCES1 Zaorsky NG, Zhang Y, Tchelebi LT, Mackley HB, Chinchilli VM, BE Zacharia. patients. Nat. Commun. 2019; 10:5172. Available from: https://doi.org/10.1038/s41467‐019‐13120‐6Google Scholar2 Graus F, Rogers LR, Posner JB. 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Published behalf Inc., Wiley Periodicals LLC.This open access under terms Creative Commons Attribution‐NonCommercial License, permits use, distribution reproduction medium, provided original work properly commercial purposes.https://doi.org/10.1161/SVIN.123.000835 receivedFebruary 23, 2023Manuscript acceptedMarch 21, 2023Originally publishedMay 2, Keywordsmedical oncologyEditorialsthrombectomystrokePDF download