Stroke: Vascular and Interventional Neurology (May 2023)
Endovascular Treatment in Patients With Acute Ischemic Stroke and Comorbid Cancer: Analysis of the Italian Registry of Endovascular Treatment in Acute Stroke
- Federica Letteri,
- Giovanni Pracucci,
- Valentina Saia,
- Fabrizio Sallustio,
- Alfredo Paolo Mascolo,
- Valerio Da Ros,
- Rossana Tassi,
- Maurizio Acampa,
- Sandra Bracco,
- Alessandro De Vito,
- Ilaria Casetta,
- Andrea Saletti,
- Guido Bigliardi,
- Stefano Vallone,
- Marta Iacobucci,
- Patrizia Nencini,
- Vanessa Palumbo,
- Sergio Nappini,
- Laura Malfatto,
- Cinzia Finocchi,
- Lucio Castellan,
- Simona Sacco,
- Nicola Giannini,
- Guido Andrea Lazzarotti,
- Roberto Cavallo,
- Chiara Comelli,
- Adriana Critelli,
- Nicola Cavasin,
- Simona Marcheselli,
- Nunzio Paolo Nuzzi,
- Mauro Magoni,
- Roberto Gasparotti,
- Paolo Invernizzi,
- Marco Pavia,
- Angelica Tinelli,
- Nicola Burdi,
- Tiziana Tassinari,
- Riccardo Padolecchia,
- Marco Petruzzellis,
- Luigi Chiumarulo,
- Maria Valeria Saddi,
- Giovanni Dui,
- Monia Russo,
- Pietro Amistà,
- Andrea Zini,
- Salvatore Mangiafico,
- Danilo Toni
Affiliations
- Federica Letteri
- Emergency Department, Stroke Unit Sapienza University Hospital Rome Italy
- Giovanni Pracucci
- Stroke Unit Ospedale Careggi‐University Hospital Firenze Italy
- Valentina Saia
- Stroke Unit Santa Corona Hospital Pietra Ligure, SV Italy
- Fabrizio Sallustio
- Stroke Unit University Hospital of Tor Vergata Rome Italy
- Alfredo Paolo Mascolo
- Stroke Unit University Hospital of Tor Vergata Rome Italy
- Valerio Da Ros
- Department of Biomedicine and Prevention University Hospital of Rome “Tor Vergata” Rome Italy
- Rossana Tassi
- Stroke Unit Azienda Ospedaliera Universitaria Senese Siena SI Italy
- Maurizio Acampa
- Stroke Unit Azienda Ospedaliera Universitaria Senese Siena SI Italy
- Sandra Bracco
- Neurointerventional Unit Azienda Ospedaliera Universitaria Senese Siena SI Italy
- Alessandro De Vito
- Clinica Neurologica University of Ferrara Ferrara Italy
- Ilaria Casetta
- Clinica Neurologica University of Ferrara Ferrara Italy
- Andrea Saletti
- Neuroradiology Department of Radiology, Arcispedale S. Anna‐University Hospital Ferrara Italy
- Guido Bigliardi
- Stroke Unit, Neurology Clinic Department of Neuroscience Civil Hospital of Baggiovara University Hospital of Modena Modena Italy
- Stefano Vallone
- Neuroradiology, Department of Neuroscience Civil Hospital of Baggiovara University Hospital of Modena Modena Italy
- Marta Iacobucci
- Department of Human Neuroscience, Interventional Neuroradiology Sapienza University Hospital Rome Italy
- Patrizia Nencini
- Stroke Unit Ospedale Careggi‐University Hospital Firenze Italy
- Vanessa Palumbo
- Stroke Unit Ospedale Careggi‐University Hospital Firenze Italy
- Sergio Nappini
- Interventional Neuroradiology Unit Ospedale Careggi‐University Hospital Firenze Italy
- Laura Malfatto
- IRCCS Ospedale Policlinico San Martino Neuroradiology and Neurology Genova Italy
- Cinzia Finocchi
- IRCCS Ospedale Policlinico San Martino Neuroradiology and Neurology Genova Italy
- Lucio Castellan
- IRCCS Ospedale Policlinico San Martino Interventional Neuroradiology Unit Genova Italy
- Simona Sacco
- Neuroscience Section Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy
- Nicola Giannini
- Department of Clinical and Experimental Medicine Neurological Institute University of Pisa Pisa Italy
- Guido Andrea Lazzarotti
- Department of Neuroradiology Azienda Ospedaliero Universitaria Pisana (AOUP) Pisa Italy
- Roberto Cavallo
- Neurology Unit San Giovanni Bosco Hospital Turin Italy
- Chiara Comelli
- Interventional Neuroradiology Unit San Giovanni Bosco Hospital Turin Italy
- Adriana Critelli
- Stroke Unit Ospedale dell'Angelo Mestre Italy
- Nicola Cavasin
- Neuroradiology Unit Ospedale dell'Angelo, USSL3 Serenissima Mestre Italy
- Simona Marcheselli
- Neurologia d'urgenza e Stroke Unit IRCCS Humanitas Research Hospital, Rozzano Milano Italy
- Nunzio Paolo Nuzzi
- Neuroradiology Unit IRCCS Humanitas Research Hospital, Rozzano Milano Italy
- Mauro Magoni
- Stroke Unit Vascular Neurology, Spedali Civili Brescia Italy
- Roberto Gasparotti
- Neuroradiology Unit Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital Brescia Italy
- Paolo Invernizzi
- Stroke Unit Fondazione Poliambulanza Brescia Italy
- Marco Pavia
- Neuroradiology Unit Fondazione Poliambulanza Brescia Italy
- Angelica Tinelli
- Stroke Unit Ospedale SS. Annunziata Taranto Italy
- Nicola Burdi
- Neuroradiology Unit “SS. Annunziata” Hospital Taranto Italy
- Tiziana Tassinari
- Stroke Unit Santa Corona Hospital Pietra Ligure, SV Italy
- Riccardo Padolecchia
- Neuroradiology Unit (R.P.) S. Corona Hospital‐ASL2 Savonese, Pietra Ligure, SV Italy
- Marco Petruzzellis
- Neurology Unit and Stroke Center Department of Basic Medical Sciences Neurosciences and Sense Organs University of Bari “Aldo Moro” Bari Italy
- Luigi Chiumarulo
- Interventional Neuroradiology Unit Policlinico Bari Bari Italy
- Maria Valeria Saddi
- Unit of Neurology San Francesco Hospital Nuoro Italy
- Giovanni Dui
- Radiology and Interventional Radiology Unit and Neurology Unit Ospedale San Francesco Nuoro Italy
- Monia Russo
- Stroke Unit Ospedale S. Maria Misericordia Rovigo Italy
- Pietro Amistà
- Neuroradiology Unit Ospedale S. Maria Misericordia Rovigo Italy
- Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna Neurology Department and Stroke Center Maggiore Hospital Bologna Italy
- Salvatore Mangiafico
- Interventional Neuroradiology Unit Ospedale Careggi‐University Hospital Firenze Italy
- Danilo Toni
- Department of Human Neurosciences University La Sapienza Rome
- DOI
- https://doi.org/10.1161/SVIN.122.000423
- Journal volume & issue
-
Vol. 3,
no. 3
Abstract
Background Acute stroke patients with comorbid cancer (CC) are more preferably addressed with endovascular treatment (EVT) than thrombolytic therapy, due to the presumed potential risk of hemorrhagic transformation and systemic bleeding. This study aims to evaluate clinical and procedural outcomes of acute stroke patients with CC receiving EVT. Methods Using the Italian Registry of Endovascular Treatment in Acute Stroke, we reviewed prospectively collected data of CC patients treated with EVT from 2011 to 2017. Outcome measures were modified Thrombolysis in Cerebral Infarction score, symptomatic intracranial hemorrhage rate, and 3‐month modified Rankin scale. We also compared CC patients with a control group without cancer (non‐comorbid cancer) receiving EVT and matched the 2 populations with a 1:1 propensity score. Results Out of 4598 stroke patients treated with EVT, 165 (3.6%) had a CC. Modified Thrombolysis in Cerebral Infarction 2b‐3 was obtained in 73.8% of CC and 74.5% of non‐comorbid cancer patients (P=0.84), whereas the rate of symptomatic intracranial hemorrhage rate was 8.2% and 6.9%, respectively. Three‐month all‐cause mortality was 33.3% in CC patients and 18.6% non‐comorbid cancer patients (P<0.001), and after propensity score was 35.4% and 22.1%, respectively (P=0.012). In CC patients, the presence of metastasis and a more recent diagnosis of cancer were significantly associated with a higher 3‐month mortality (P=0.018 and 0.021, respectively). Breast cancer showed a significant correlation with mild or no disability (odds ratio, 3.32; CI, 1.28–8.67; P=0.014) and less death cases at 3‐months (odds ratio, 0.44; CI, 0.16–1.21; P=0.114) compared to the other most represented malignancies. Conclusion Although 3‐month all‐cause mortality was significantly higher in CC patients, successful recanalization and hemorrhagic transformation rate were comparable in both groups. In cancer patients, a metastatic and active disease seem to be associated with a poorer functional outcome, whereas a diagnosis of breast cancer appears to be more frequent in patients with a mild or no disability at long term.
Keywords
- active cancer
- comorbid cancer
- endovascular treatment
- ischemic stroke
- metastasis
- 3‐month functional independence