Objective:

To determine covariates associated with long-term outcomes for patients with acute ischemic stroke (AIS) who had active cancer and underwent endovascular therapy.

Background:

Intraarterial therapy (IAT) is the standard of care for all AIS patients, even those with active cancer. Many studies show poor outcomes for patients with active malignancy compared to those without who undergo IAT. Few studies, however, have identified other characteristics that may contribute to 90-day modified Rankin scale (mRS) scores for patients with active cancer undergoing IAT.

Design/Methods:

This retrospective study included patients (age ≥ 18) admitted from 07/18-10/20 with AIS, treated by IAT, and had active cancer. The primary outcome was 90-day mRS; secondary outcomes were complications. The receiver operating characteristic area under the curve (AUC) was used to determine optimal admission national institutes of health scores (NIHSS) to obtain a 90-day mRS of 0-2. Alpha=0.05.

Results:

There were 53 patients; 42% had a 90-day mRS of 0-2 and 58% had 3-6. The median (interquartile range) age was 71 years (64-81), 58% were male, and the median admission NIHSS was 12 (6-17). Compared to patients who had a 90-day mRS of 3-6, patients with a 0-2 had a significantly lower median admission NIHSS (6.5 (3-15) vs. 15 (9-22), p=0.006), more had IV-tPA (41% vs. 13%, p=0.02), and significantly less experienced a thromboembolic event during their hospital course (17% vs. 57%, p=0.004). No patients with an mRS of 0-2 had a
symptomatic intracranial hemorrhage, respectively (0% vs. 10%, p=0.13). The NIHSS cut-off for predicting a favorable 90-day mRS was 8.2 and indicated a moderate fit.

Conclusions:

This data suggests that both admission NIHSS and thromboembolic events were strong predictors of 90-day outcomes. Using an NIHSS cut-off of 8.2 for patients with active cancer in determining who should receive IAT may increase the probability of a favorable 90-day outcome.