Abstract Number ‐ 20: Predictors of Outcomes for Patients with Malignancy and Acute Ischemic Stroke Undergoing Endovascular Therapy

Introduction Patients with active cancer face an increased risk for stroke. Randomized trials studying the efficacy of endovascular therapy for patients with large vessel occlusions generally excluded patients with cancer. Herein, we sought to better understand predictors of outcome for active cancer patients undergoing mechanical thrombectomy for acute ischemic stroke. Methods We conducted a retrospective cohort study of stroke thrombectomy cases performed at our institution from January 2010 to November 2021. Baseline clinical characteristics (age, gender, cancer type, use of anticoagulation, NIHSS, use of tPA, time to reperfusion) were recorded. Study outcomes were successful endovascular reperfusion (≥ TICI 2b) and poor clinical outcome, defined as inpatient death or disposition to hospice. Pearson Chi‐square test and Fisher’s exact test were used to analyze categorical variables, and Mann‐Whitney U tests were used for continuous variables. Multivariable logistic regression analyses were performed to evaluate for independent associations between baseline characteristics and study outcomes. Results Between 2010–2021, we identified 49 patients with active cancer who underwent mechanical thrombectomy for stroke. Their mean age was 63 years (SD, 12), and 43% were men. The leading cancer types were lung (33%) and colorectal (14%). Successful reperfusion was achieved in 78% (95% CI, 66–90%) of patients, and 49% (95% CI, 34–63%) ultimately had a poor clinical outcome. Multivariable analyses yielded no significant predictors for successful reperfusion, while higher NIHSS (1.03, 95% CI, 1.01‐1.06, p = 0.011) and higher cancer stage (1.19, 95% CI, 1.04‐1.34, p = 0.014) were found to be predictors for poor clinical outcome. Conclusions The link between cancer and stroke has become increasingly appreciated. As tPA is often contraindicated in cancer patients with stroke because of recent bleeding or anticoagulant use, thrombectomy may be the only intervention to preserve one’s quality of life. However, we found that despite a high successful reperfusion rate, nearly half of these patients died or were made hospice during the index hospitalization. Future studies should investigate the reasons for poor clinical outcomes in these patients and whether different antithrombotic, blood pressure, or anti‐neoplastic strategies after thrombectomy could improve outcomes.