Trends in Thrombolysis and Thrombectomy Use in Patients With Ischemic Stroke and Cancer

Abstract

Background To determine how intravenous thrombolysis (IV‐tPA) and mechanical thrombectomy (MT) use has changed in patients with acute ischemic stroke (AIS) with cancer (AIS‐C) compared with patients with AIS and noncancer (AIS‐NC) in the United States since publication of pivotal MT trials. Methods All primary AIS‐NC and AIS‐C admissions (weighted N=5 748 357) were identified from the 2007 to 2019 Nationwide Inpatient Sample. Joinpoint and multivariable‐adjusted models with interaction terms were used to compare the rate of change in IV‐tPA and MT use between AIS‐C and AIS‐NC. Results From 2007 to 2019, 4.4% of AIS admissions had active cancer. Overall IV‐tPA use in AIS‐C (6.4%) was lower than that of AIS‐NC (8.5%) ( P <0.001) but use differed by cancer subtype (hematologic, 7.2%; metastatic, 4.2%). IV‐tPA use increased over time in all cancers, but analysis of status‐by‐time interaction revealed that the pace of increase was slower in metastatic compared with AIS‐NC admissions (rate ratio, 0.98; P =0.015) per year. In contrast, MT use in AIS‐C (2.2%) was greater than that of AIS‐NC (1.9%), but use was highest in metastatic (2.5%) and lowest in hematologic cancers (1.6%) ( P values for all pairwise comparisons <0.001). MT use increased at a faster pace in metastatic AIS‐C (rate ratio, 1.06; P =0.001)/year compared with AIS‐NC. In‐hospital all‐cause mortality in AIS‐NC was 4.2% compared with 8.2% in AIS‐C ( P <0.001). Mortality declined over time in all cancer groups, but the pace of decline was faster in solid and metastatic AIS‐C compared with AIS‐NC ( P values <0.01). Conclusions Use of IV‐tPA and MT has increased in AIS‐C over the past decade. Contrary to prior studies, the current frequency and pace of increase in MT use is greater in metastatic AIS‐C compared with AIS‐NC. Future studies are needed to determine whether AIS‐C are more predisposed to large‐vessel occlusion.