Investigating Outcomes Post–Endovascular Thrombectomy in Acute Stroke Patients With Cancer

Abstract

Background and ObjectivesCancer is a common comorbidity in patients with acute ischemic stroke (AIS). Randomized controlled trials that established endovascular thrombectomy (EVT) as the standard of care for large vessel occlusion generally excluded patients with cancer. As such, the clinical benefits of endovascular thrombectomy in the cancer population are currently poorly established. We examine clinical outcomes of patients with cancer who underwent EVT using a large inpatient database, the National Inpatient Sample (NIS).MethodsThe NIS was queried for AIS admission between 2016 and 2019, and patients with cancer were identified. Baseline demographics, comorbidities, reperfusion therapies, and outcomes were compared between patients with AIS with and without cancer. For patients who underwent EVT, propensity score matching was used to study primary outcomes such as risk of intracranial hemorrhage, hospital length of stay, and discharge disposition.ResultsDuring the study period, 2,677,200 patients were hospitalized with AIS, 228,800 (8.5%) of whom had a diagnosis of cancer. A total of 132,210 patients underwent EVT, of which 8,935 (6.8%) had cancer. Over 20% of patients with cancer who underwent EVT had a favorable outcome of a routine discharge home without services. On adjusted propensity score analysis, patients with cancer who underwent EVT had similar rates of intracranial hemorrhage (OR 1.03, CI 0.79–1.33,p= 0.90) and odds of a discharge home, with a significantly higher rate of prolonged hospitalization greater than 10 days (OR 1.34, CI 1.07–1.68,p= 0.01). Compared with patients without cancer, patients with metastatic cancer who underwent EVT also had similar rates of intracranial hemorrhage (OR 1.03, CI 0.64–1.67,p= 1.00) and likelihood of routine discharge (OR 0.83, CI 0.51–1.35,p= 0.54) but higher rates of in-hospital mortality (OR 2.72, CI 1.52–4.90,p< 0.01).DiscussionOur findings show that in contemporary medical practice, patients with acute stroke with comorbid cancer or metastatic cancer who undergo endovascular thrombectomy have similar rates of intracranial hemorrhage and favorable discharges as patients without cancer. This suggests that patients with AIS who meet the criteria for reperfusion therapy may be considered in the setting of a comorbid cancer diagnosis.