ABSTRACT NUMBER: ESOC2026A16 CLOT COMPOSITION ANALYSIS IN ISCHEMIC STROKE OF CANCER PATIENTS: A SYSTEMATIC REVIEW

Abstract Background and aims Cancer patients are at high risk of ischemic stroke (IS) and worse outcomes. Endovascular thrombectomy (EVT) in IS treatment has made the analysis of retrieved clots available. This review aimed to identify studies and case reports on IS clot analysis in cancer patients (PROSPERO Registry Number CRD420251042353). Methods The databases of PubMed/MEDLINE and SCOPUS were systematically searched for studies and case reports involving pathological analysis of clots retrieved from IS patients with cancer. Studies on children, other retrieved materials, benign tumors, or where the results of cancer patients were not explicitly stated were excluded. Results 23 case reports and 9 heterogeneous studies with larger clot numbers were included. Seventeen case reports referred to tumor embolism, 3 to cancer-related thrombosis (Trousseau’s syndrome), 2 to mucin embolism, and 1 to post-radiation stenosis. Most clots had an atypical white appearance, with tumor cells and mucin in tumor or mucin embolism respectively, or a platelet predominance for cancer-related thrombosis. Six of 7 larger-scale studies reported significantly higher platelet and lower red blood cell proportions for clots in cancer patients, and 5 studies showed no increased percentages of white blood cells or neutrophil extracellular traps. Conclusions The available studies were heterogeneous, and relatively small. However, our results show that the clots of cancer patients tend to be white and predominantly platelet-rich. Atypical appearances also occur in cases of tumor or mucin embolism. These findings bear implications for the secondary prophylaxis after in cancer patients, and including tumor work-up in platelet-rich clots and no other identifiable cause. Conflict of interest Athina-Maria Aloizou, David-Dimitrios Chlorogiannis, Jeyanthan Charles James, Dimitra Aloizou, Ralf Gold, Christos Krogias: nothing to disclose.