Elevated CA125 is Related to Stroke Due to Cancer- Associated Hypercoagulation

Ischemic stroke in patients with unresectable pancreatic and gastric cancer

BACKGROUND

Thromboembolism, including ischemic stroke and venous thromboembolism (VTE), is a critical complication in patients with advanced cancer. Pancreatic cancer and gastric cancer are classified as "very high risk" cancers based on the Khorana score, a risk model for VTE. However, the cumulative incidence of ischemic stroke in patients with unresectable pancreatic and gastric cancers has not been elucidated. This study evaluated the incidence and mortality of ischemic stroke in patients with unresectable pancreatic and gastric cancer.

METHODS

This retrospective, single-center cohort study included patients diagnosed with unresectable pancreatic or gastric cancer between January 2009 and December 2021.

RESULTS

Among 276 patients, ischemic stroke occurred in 18 patients. All 18 patients were categorized into cancer-associated stroke (CAS), including cancer-related coagulopathy, by a board certified fellow. The 1-year cumulative incidence rates were 10.2% in patients with unresectable pancreatic cancer and 5.8% in patients with unresectable gastric cancer (P = 0.22). The median survival time after stroke was significantly shorter for patients with unresectable pancreatic cancer than for patients with unresectable gastric cancer (41 days vs 116 days, P < 0.05). In contrast, no significant difference was observed in overall survival (OS) between patients with and without ischemic stroke (244 days vs 221 days, P = 0.66).

CONCLUSION

This study's findings indicated that CAS accounts for most ischemic stroke in patients with unresectable pancreatic and gastric cancers. Moreover, the prognosis after ischemic stroke was significantly worse in patients with unresectable pancreatic cancer. However, ischemic stroke itself may not influence OS in patients with unresectable pancreatic or gastric cancer.

Absence of the Susceptibility Vessel Sign with Cancer-Associated Hypercoagulability-Related Stroke

BACKGROUND AND PURPOSE

The susceptibility vessel sign, a hypointense signal on MR T2-weighted gradient-recalled echo images, is associated with erythrocyte-predominant thrombi, which are often present in cardioembolism. In contrast, cancer-associated hypercoagulability (CAH)-related stroke, which is presumably caused by fibrin-predominant thrombi, is associated with the absence of the susceptibility vessel sign. We hypothesized that the prevalence of the susceptibility vessel sign may be helpful in distinguishing CAH-related stroke from cardioembolism. This study attempted to validate this hypothesis and investigated the usefulness of the susceptibility vessel sign in differentiating CAH-related stroke from cardioembolism.

MATERIALS AND METHODS

We retrospectively studied patients with both CAH-related stroke (CAH group) and cardioembolism (cardioembolism group) who had major cerebral artery occlusion on MRA that was performed within 6 hours of stroke onset. All patients visited our department from 2015 to 2021. CAH-related stroke was defined as the following: 1) complication of active cancer, 2) pretreatment D-dimer value of >3 μg/mL, 3) multiple vascular territory infarctions, and 4) lack of any other specifically identified causes of stroke. We compared susceptibility vessel sign positivity rates within each group. Multivariable logistic regression analysis was used to assess the association between the absence of the susceptibility vessel sign and CAH-related stroke.

RESULTS

Of 691 patients with CAH-related stroke or cardioembolism, major cerebral artery occlusion was observed in 10 patients in the CAH group and 198 patients in the cardioembolism group. The absence of the susceptibility vessel sign was identified in 55 of 208 patients and was significantly more frequent in the CAH group versus the cardioembolism group (90% versus 24%, P < .05). For predicting CAH-related stroke, the absence of the susceptibility vessel sign demonstrated a sensitivity of 90% (95% CI, 59%-99%), specificity of 78% (95% CI, 71%-83%), a positive predictive value of 18% (95% CI, 10-31), a negative predictive value of 99% (95% CI, 96%-99%), and a likelihood ratio of 4.06. Multivariable logistic regression analysis revealed that the absence of the susceptibility vessel sign was independently associated with CAH-related stroke (OR, 43; 95% CI, 6.8-863; P < .01).

CONCLUSIONS

The absence of the susceptibility vessel sign was more frequent in CAH-related stroke than in cardioembolism. These findings could potentially be helpful for clinical management and differentiating cardioembolism and CAH-related stroke.

Application of triboelectric nanogenerator (TENG) in cancer prevention and adjuvant therapy

Cancer is a malignant tumor that kills about 940,000 people worldwide each year. In addition, about 30-77 % of cancer patients will experience cancer metastasis and recurrence, which can increase the cancer mortality rate without prompt treatment. According to the US Food and Drug Administration, wearable devices can detect several physiological indicators of patients to reflect their health status and adjuvant cancer treatment. Based on the triboelectric effect and electrostatic induction phenomenon, triboelectric nanopower generation (TENG) technology can convert mechanical energy into electricity and drive small electronic devices. This article reviewed the research status of TENG in the areas of cancer prevention and adjuvant therapy. TENG can be used for cancer prevention with advanced sensors. At the same time, electrical stimulation generated by TENG can also be used to help inhibit the growth of cancer cells to reduce the proliferation, recurrence, and metastasis of cancer cells. This review will promote the practical application of TENG in healthcare and provide clean and sustainable energy solutions for wearable bioelectronic systems.

Cancer patients and ischemic stroke

Patients with cancer have an increased risk of ischemic stroke compared to the general population. Additionally, these patients have a worse prognosis compared to stroke patients without cancer. Activation of coagulation appears to play a key role in the pathophysiology of ischemic stroke in patients with cancer. However, the underlying mechanisms remain unknown. Moreover, we do not have a way to identify cancer patients with a high risk of stroke and cannot develop prevention strategies. Therefore, there is an urgent need for neurologists and oncologists to develop screening and prevention strategies for stroke in patients with cancer. In this review, we summarize the characteristics of cancer patients at a high risk of stroke, the predictors for the development of stroke and survival in cancer patients, and possible treatments.

Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer

Background

Paraneoplastic ischemic stroke has a poor prognosis. We have recently reported an algorithm based on the number of ischemic territories, C-reactive protein (CRP), lactate dehydrogenase (LDH), and granulocytosis to predict the underlying active cancer in a case-control setting. However, co-occurrence of cancer and stroke might also be merely incidental.

Objective

To detect cancer-associated ischemic stroke in a large, unselected cohort of consecutive stroke patients by detailed analysis of ischemic stroke associated with specific cancer subtypes and comparison to patients with bacterial endocarditis.

Methods

Retrospective single-center cohort study of consecutive 1612 ischemic strokes with magnetic resonance imaging, CRP, LDH, and relative granulocytosis data was performed, including identification of active cancers, history of now inactive cancers, and the diagnosis of endocarditis. The previously developed algorithm to detect paraneoplastic cancer was applied. Tumor types associated with paraneoplastic stroke were used to optimize the diagnostic algorithm.

Results

Ischemic strokes associated with active cancer, but also endocarditis, were associated with more ischemic territories as well as higher CRP and LDH levels. Our previous algorithm identified active cancer-associated strokes with a specificity of 83% and sensitivity of 52%. Ischemic strokes associated with lung, pancreatic, and colorectal (LPC) cancers but not with breast and prostate cancers showed more frequent and prominent characteristics of paraneoplastic stroke. A multiple logistic regression model optimized to identify LPC cancers detected active cancer with a sensitivity of 77.8% and specificity of 81.4%. The positive predictive value (PPV) for all active cancers was 13.1%.

Conclusion

Standard clinical examinations can be employed to identify suspect paraneoplastic stroke with an adequate sensitivity, specificity, and PPV when it is considered that the association of ischemic stroke with breast and prostate cancers in the stroke-prone elderly population might be largely incidental.

Ischemic Stroke in Cancer: Mechanisms, Biomarkers, and Implications for Treatment

Ischemic stroke is an important cause of morbidity and mortality in cancer patients. The underlying mechanisms linking cancer and stroke are not completely understood. Long-standing and more recent evidence suggests that cancer-associated prothrombotic states, along with treatment-related vascular toxicity, such as with chemotherapy and immunotherapy, contribute to an increased risk of ischemic stroke in cancer patients. Novel biomarkers, including coagulation, platelet and endothelial markers, cell-free DNA, and extracellular vesicles are being investigated for their potential to improve risk stratification and patient selection for clinical trials and to help guide personalized antithrombotic strategies. Treatment of cancer-related stroke poses unique challenges, including the need to balance the risk of recurrent stroke and other thromboembolic events with that of bleeding associated with antithrombotic therapy. In addition, how and when to restart cancer treatment after stroke remains unclear. In this review, we summarize current knowledge on the mechanisms underlying ischemic stroke in cancer, propose an etiological classification system unique to cancer-related stroke to help guide patient characterization, provide an overview of promising biomarkers and their clinical utility, and discuss the current state of evidence-based management strategies for cancer-related stroke. Ultimately, a personalized approach to stroke prevention and treatment is required in cancer patients, considering both the underlying cancer biology and the individual patient's risk profile.

Internal carotid bulb occlusion by a giant thrombus after thoracoscopic left upper lung lobectomy successfully treated with endovascular stenting: a case report

BACKGROUND

Perioperative acute ischemic stroke following lung resection is relatively rare, though a devastating complication. Specifically, patients undergoing left upper lung lobectomy for lung cancer are likely to develop perioperative acute ischemic stroke.

CASE PRESENTATION

A 67-year-old man underwent thoracoscopic left upper lung lobectomy for lung adenocarcinoma; he experienced sudden-onset left hemiparesis and dysarthria on the morning of the second postoperative day. Angiography revealed occlusion of the bulbs of the right internal and external carotid arteries by a giant thrombus, which could not be removed through endovascular thrombectomy. We deployed a stent at the right carotid bifurcation to foist the giant thrombus, achieving revascularization 4 h after the onset. Treatment response was assessed as good improvement with a modified Rankin scale score of 0, and the patient was discharged home 19 days after symptom onset.

CONCLUSIONS

We present a unique case of carotid bulb thromboembolism resulting from a giant thrombus following thoracoscopic left upper lung lobectomy, for which endovascular stenting was effective.