Abstract A074: Endovascular Stroke Thrombectomy for Patients with Metastatic Cancer

Introduction: Endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is supported by high-quality evidence, but patients with metastatic cancer have histocally been excluded from clinical trials. Thus, the safety and efficacy of EVT compared to best medical management (BMM) for LVO patients with metastatic cancer remains unclear. The objective of this retrospective cohort study is to assess outcomes of EVT for LVO stroke patients with concomitant metastatic cancer compared with BMM. Methods: The study population included adult patients with LVO stroke (internal carotid, middle cerebral, or basilar artery occlusion) and metastatic cancer from the 2016 to 2022 Nationwide Readmissions Database. Patients with brain tumors, lymphoma, leukemia, National Institutes of Health Stroke Scale (NIHSS) less than 6, or missing data were excluded. Propensity score matching was performed using 1-to-1 nearest-neighbor matching. The primary outcome was functional independence at hospital discharge. Secondary outcomes included discharge to home, hospital length of stay, in-hospital mortality, and 180-day mortality. Outcomes were also assessed in subgroups of patients who died during the initial hospitalization or within six months. Results: Of 5629 included patients, 3590 remained after propensity score matching (1833 EVT, 1757 BMM). Median age was 70 years for both groups; 52% were women. Compared to BMM, EVT was associated with higher rates of functional independence (17.8% vs 8.7%; P<.001) and discharge to home (42.3% vs 34.1%; P=0.001), with no significant difference in in-hospital mortality (22.8% vs 24.3%; P=0.49), hospital length of stay (median 7 vs 6 days; P=0.34), or 180-day mortality (28.4% vs 28.5%; P=0.98). Among patients who suffered in-hospital mortality (n=845), there was no significant difference in length of stay (LOS) (median 5 vs 4 days, p=0.52). Among patients who survived the index hospitalization but later died within 180 days (N=134), EVT was associated with higher rates of interim functional independence (33.8% vs 12.3%, p=0.014). Conclusions: Among LVO stroke patients with metastatic cancer, EVT was associated with significantly higher rates of functional independence without change in mortality or LOS.