Mid-Term Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke in Patients with Active Cancer: a Propensity-Matched Study.

BACKGROUND AND PURPOSE: Active cancer (AC) is associated with increased risk of large vessel occlusion related acute ischemic stroke (LVO-AIS). We aimed to evaluate technical, clinical, and oncological outcomes of mechanical thrombectomy (MT) in patients with AC presenting with LVO-AIS. METHODS: Between January 2017 and January 2023, retrospectively, LVO-AIS patients with AC were matched 1:3 with controls for demographic, clinical, imaging and therapeutic characteristics. We assessed the recanalization success, early neurological improvement, symptomatic intracranial hemorrhage (sICH) and clinical outcome. In AC patients, oncological characteristics and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) were considered for the univariate analyses. RESULTS: Eighty-one AC patients were matched to 243 controls. Both groups presented comparable regarding procedural outcomes, early neurological improvement and sICH after MT. At 3 months, compared to control group, AC patients achieved lower rate of mRS 0-2 (28.4% vs. 40.3%; p = 0.042) and higher rate of mortality (42.0% vs. 22.2%; p = 0.001). However, AC patients with ECOG-PS = 0 presented comparable mRS (cOR=0.88, 95% CI: 0.45-1.73; p=0.72) and mortality (24.1% vs 22.2%; p=0.64) rates to non-AC patients and more favorable outcomes than AC patients with ECOG-PS ≥ 1 (mRS cOR= 2.39, 95% CI: 1.05-5.5; p=0.039; mortality 24.1% vs 51.9%, p = 0.02). CONCLUSIONS: In AC patients, MT appears technically as safe and effective as in non-AC patients. Despite comparable short-term outcomes, mid-term prognosis remains poor. ECOG-PS 0 showed to be associated to a better clinical outcome and should be considered in the decision making regarding the MT.