ABSTRACT NUMBER: ESOC2026A1310 CANCER-RELATED STROKE; A CASE SERIES DESCRIBING CLINICAL FEATURES, MANAGAMENT AND OUTCOMES

Abstract Background and aims Cancer-related stroke (CRS) has emerged as a distinct stroke subtype, accounting for 5-10% of all ischaemic strokes, with specific pathophysiological mechanisms. Despite growing awareness, the phenotype of affected patients and optimal management remain unclear due to limited evidence. This study aimed to characterise the clinical profile of patients with CRS, describe antithrombotic management decisions and report short-term outcomes. Methods We conducted a case series including 10 adult patients with CRS managed at our centre in 2025. We collected demographic, clinical, oncological and laboratory data, antithrombotic treatment and outcomes. Continuous variables were summarised as median/interquartile range (IQR), and categorical variables as number/percentage. Results Ten patients were included (median 61.5 years, IQR 57.3–68.8; 40% women). Pre-stroke functional independence was preserved (median modified Rankin Scale [mRS] 0, IQR 0–1). In six patients (60%), stroke was the first manifestation of the underlying cancer; lung cancer was the most frequent malignancy (70%) and 90% had metastatic disease. Median baseline NIHSS was 3.5 (IQR 3–12.5), and 40% showed multi-territorial infarcts. Median D-dimer was markedly elevated (30,090 ng/mL; IQR 14,686–178,528; n=7). Anticoagulation was prescribed in 30% of patients. During follow-up, stroke recurrence occurred in one patient (10%) and haemorrhagic transformation in three (30%). Overall mortality at 90 days reached 60% (40% during hospitalisation). Conclusions This case series highlights the complexity and specific clinical context of CRS patients. Consistent with previous reports, prognosis was poor with high mortality. Treatment decision-making is challenging and requires individualised approaches. Further research is needed to guide clinical practice. Conflict of interest nothing to disclose