Temporal trends, outcomes, and predictors for endovascular thrombectomy in acute stroke patients with and without cancer

Background: Purpose: The benefits and risks of endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS) and a history of cancer remain unclear. This study aimed to assess procedural effectiveness, safety, clinical outcomes, and their trends over time. Methods: We analyzed data from 2011 to 2023 from binational EVT registries in Taiwan and South Korea. Patients with a history of cancer were propensity score matched (1:2) to non-cancer controls based on age, stroke severity, risk factors, imaging, and treatment. Outcomes included reperfusion, symptomatic intracerebral hemorrhage (SICH), early neurological deterioration (END), in-hospital and 90-day mortality, and favorable 90-day outcomes. Results: Of 6526 stroke patients who received EVT, 473 (7.2 %) had cancer. After matching, 294 cancer patients were compared with 549 controls. Successful reperfusion and SICH rates were similar. Cancer patients had higher END (17.0 % vs. 10.4 %), in-hospital mortality (19.0 % vs. 8.6 %), 90-day mortality (35.4 % vs. 16.2 %), and lower chances of favorable 90-day outcomes (23.1 % vs. 35.7 %). Higher HDL and platelet count in cancer patients were linked to better outcomes. The proportion of cancer patients undergoing EVT increased over time with improved reperfusion and lower SICH rates. Conclusions: EVT is safe and effective for AIS patients with cancer, with similar reperfusion and complication rates as non-cancer patients. However, they often have worse outcomes. Laboratory markers can help personalize prognosis. Evolving treatment patterns suggest increasing clinician confidence in this group. However, due to missing cancer-specific details, our findings should not be generalized to all cancer populations, especially those with advanced or terminal malignancies.