BACKGROUND AND PURPOSE Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials. METHODS We searched the National Readmission Database for LVO patients treated with MT between 2016-2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders. RESULTS Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P<0.001). Patients with MC had similar rates of intracerebral hemorrhage (20% vs. 21%) but were less likely to receive tissue plasminogen activator (13% vs. 23%, P<0.001). In unadjusted analysis, MC patients as compared to cancer-free patients had a higher in-hospital mortality rate and were less likely to be discharged to home (36% vs. 42%, P=0.014). On multivariate regression adjusting for confounders, mortality was the only outcome that was significantly higher in the MC group than in the cancerfree group (P<0.001). CONCLUSION LVO patients with MC have higher mortality and more infectious and thrombotic complications than cancer-free patients. MT nonetheless can result in survival with good outcome in slightly over one-third of patients.

中文翻译：

---

转移性癌症患者急性缺血性中风的机械血栓切除术：全国横断面分析。

背景和目的机械血栓切除术 (MT) 是大血管闭塞 (LVO) 急性缺血性卒中的标准治疗方法。患有活动性恶性肿瘤的患者中风风险增加，但被排除在 MT 试验之外。方法 我们搜索了 2016-2018 年间接受 MT 治疗的 LVO 患者的国家再入院数据库，并将无癌患者与转移癌 (MC) 患者的特征和结果进行了比较。主要结果是全因住院死亡率和有利结果，定义为常规出院回家（无论是否提供家庭服务）。多元回归用于调整混杂因素。结果 在接受 MT 治疗的 40,537 名 LVO 患者中，933 名 (2.3%) 诊断为 MC。与无癌患者相比，MC 患者的年龄和中风严重程度相似，但总体疾病严重程度更高。MC 中发生率较高的住院并发症包括肺炎、败血症、急性冠脉综合征、深静脉血栓形成和肺栓塞 (P<0.001)。MC 患者的脑出血率相似（20% 对 21%），但接受组织纤溶酶原激活剂的可能性较低（13% 对 23%，P<0.001）。在未经调整的分析中，与无癌症患者相比，MC 患者的院内死亡率更高，出院回家的可能性更小（36% 对 42%，P=0.014）。在对混杂因素进行多变量回归调整后，死亡率是 MC 组中唯一显着高于无癌组的结果 (P<0.001)。结论 伴有 MC 的 LVO 患者比无癌患者具有更高的死亡率和更多的感染和血栓并发症。尽管如此，MT 仍可使略高于三分之一的患者存活并获得良好结果。