Endovascular Thrombectomy for Large Vessel Occlusion Stroke in Patients with Metastatic Cancer

BACKGROUND AND PURPOSE: Endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is supported by high-quality evidence, but the safety and efficacy of EVT for patients with concomitant metastatic cancer is unclear. We aimed to compare outcomes of EVT versus best medical management (BMM) for LVO stroke patients with metastatic cancer. MATERIALS AND METHODS: This retrospective cohort study of the 2016-2022 Nationwide Readmissions Database includes adult patients with LVO stroke (internal carotid, middle cerebral, or basilar artery occlusion) and metastatic cancer. Propensity score matching (PSM) was performed using 1-to-1 nearest-neighbor matching. The primary outcome was early functional independence at hospital discharge. Secondary outcomes included discharge to home, hospital length of stay, in-hospital mortality, and 180-day mortality. Outcomes were compared between those treated with EVT or BMM, and treatment effects are reported as risk differences (RD), risk ratios (RR), or hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: Of 5629 patients, 3590 remained after PSM (1833 EVT, 1757 BMM). Compared to BMM, EVT was associated with significantly higher rates of early functional independence (17.8% vs 8.7%; RD 9.1% [95%CI 5.1 to 13.1], RR 2.04 [95%CI 1.51-2.76]) and discharge to home (42.3% vs 34.1%; RD 8.2% [95%CI 3.2 to 13.2], RR 1.24 [95%CI 1.09-1.42]), with no difference in hospital length of stay (median 7 vs 6 days; P=0.34), in-hospital mortality (22.8% vs 24.3%; RD -1.5% [95%CI -5.6 to 2.6]), or 180-day mortality (30.3% vs 30.0%; HR 0.99 [95%CI 0.83-1.18]). Among patients who suffered in-hospital mortality (n=845), there was no significant difference in length of stay (median 5 vs 4 days, p=0.52). Among patients who survived the index hospitalization but later died within 180 days (N=185), EVT was associated with higher rates of interim functional independence (26.8% vs 12.7%; RR 2.11 [95%CI 1.02-4.37]). CONCLUSIONS: Among LVO stroke patients with metastatic cancer, EVT was associated with significantly higher rates of functional independence compared to BMM, without altering overall survival.