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Toruno M, Al-Janabi O, Karaman I, Ghozy S, Senol YC, Kobeissi H, Kadirvel R, Ashdown B, Kallmes DF. Mechanical thrombectomy for the treatment of large vessel occlusion due to cancer-related cerebral embolism: A systematic review. Interv Neuroradiol 2024:15910199241230356. [PMID: 38332668 DOI: 10.1177/15910199241230356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Cancer-related cerebral embolism due to direct tumor embolization results in a rare acute ischemic stroke with large vessel occlusion (LVO). Despite the established status of mechanical thrombectomy (MT) in LVO management, its effectiveness and safety remains inadequately explored in this specific patient group. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the Nested Knowledge AutoLit software, encompassing databases like Embase, PubMed, Scopus, and Web of Science, from their inception up to 9 May 2023. RESULTS In the review of 35 studies encompassing 37 cases, mean patient age was 52 years, and 30% were female. Cardiac myxoma (29.7%), cardiac papillary fibroelastoma (16.2%), and squamous cell carcinoma of the lung (8.1%) were the most frequent underlying cancers. The left middle cerebral artery was the most commonly affected occlusion site (24.3%). Of the patients, 67.5% underwent MT alone, while 32.5% received MT combined with intravenous thrombolysis. Successful reperfusion (thrombolysis in cerebral infarction (TICI) 2b-3) was achieved in 89.1% of cases, with 59.4% reaching TICI 3. Functional independence was observed in 29.7% of patients. CONCLUSION While limitations exist, this comprehensive study highlights the potential benefits of MT in a patient group historically excluded from major trials, warranting further investigation.
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Affiliation(s)
| | - Omar Al-Janabi
- Department of Neurology, University of Arizona-Tucson, USA
| | - Irem Karaman
- Bahcesehir University School of Medicine, Istambul, Turkey
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Yigit Can Senol
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Boyd Ashdown
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Mosconi MG, Capponi A, Paciaroni M. Systemic thrombolysis in patients with acute stroke and active cancer: a systematic review and meta-analysis. Intern Emerg Med 2023; 18:1843-1850. [PMID: 37337013 DOI: 10.1007/s11739-023-03312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/11/2023] [Indexed: 06/21/2023]
Abstract
Cancer patients frequently have concomitant cerebrovascular diseases, which significantly worsen their prognosis. Prospective studies validating intravenous thrombolysis (IVT) safety profile in patients with acute ischemic stroke and active cancer are still lacking. Therefore, we aimed to evaluate IVT's efficacy and safety profile in acute ischemic stroke patients with comorbid active cancer. We included in a meta-analysis all relevant published studies, including patients with acute ischemic stroke with or without active cancer and receiving IVT, according to recommendations for IVT treatment for acute ischemic stroke. The primary outcomes were: any intracerebral hemorrhage, all-cause mortality, and good functional outcome reported as modified Rankin Scale (mRS) ≤ 2 at the end of the scheduled follow-up period. We included 11 studies in the meta-analysis. IVT was not associated with a significant increase in the incidence of intracerebral hemorrhage (OR 1.35; 95% CI 0.85-2.14; I2 76%), nor with a significant increase in death for any cause (OR 1.26; 95% CI 0.91-1.75; I2 71%); furthermore, IVT did not influence mRS between cancer and non-active cancer stroke patients (OR 0.72; 95% CI 0.35-1.49; I2 59%). IVT seems safe and effective in patients with ischemic stroke and concomitant cancer. Due to the low overall quality of the evidence, high-quality randomized controlled trials with adequate sample sizes are needed.
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Affiliation(s)
- Maria Giulia Mosconi
- Internal and Vascular and Emergency Medicine-Stroke Unit, Università degli Studi di Perugia/Azienda Ospedaliera Santa Maria della Misericordia, 06129, Perugia, Italy.
| | - Andrea Capponi
- Emergency Department, University of Florence, Florence, Italy
| | - Maurizio Paciaroni
- Internal and Vascular and Emergency Medicine-Stroke Unit, Università degli Studi di Perugia/Azienda Ospedaliera Santa Maria della Misericordia, 06129, Perugia, Italy
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Zuber M. Stroke and cancer. Rev Neurol (Paris) 2023; 179:417-424. [PMID: 37024364 DOI: 10.1016/j.neurol.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023]
Abstract
Association between stroke and cancer is well-established and has led to a growing literature over the past decades. Risk of ischemic and hemorrhagic stroke is increased among patients with newly diagnosed cancer and 5-10% of stroke patients bear an active cancer. All cancers are concerned, but hematological malignancy in childhood and adenocarcinoma from lung, digestive tract and pancreas in adults are most usually identified. Unique stroke mechanisms are dominated by hypercoagulation, a condition that may lead to both arterial and venous cerebral thromboembolism. Direct tumor effects, infections and therapies may also play some active role in stroke happening. Magnetic Resonance Imaging (MRI) is helpful in: i) detecting typical patterns of ischemic stroke in cancer patients (i.e. concomitant strokes in multiple arterial territories); ii) distinguishing spontaneous intracerebral hemorrhage from tumor bleeding. Recent literature suggests that acute treatment using intravenous thrombolysis is safe in non-metastatic cancer patients. First results from endovascular procedures are reassuring, although arterial reobstruction is more frequent than in cancer-free patients. Prognosis is worse in patients with compared to those without cancer and mostly depends upon several predictors such as the initial stroke severity and the presence of metastasis. In the present review, we aim to provide some practical responses to neurologists about the stroke-cancer association, including prevalence, stroke mechanisms, biomarkers indicative for an occult cancer, influence of neoplasia on acute and long-term stroke treatments, and prognosis.
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Affiliation(s)
- M Zuber
- Groupe hospitalier Paris Saint-Joseph, université Paris Cité, Paris, France.
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Peng C, Yang F, Peng L, Zhang C, Lin Z, Chen C, Gao H, He J, Jin Z. Temporal trends and outcomes in acute ischaemic stroke patients with a current or historical diagnosis of cancer. Eur J Neurol 2023; 30:951-962. [PMID: 36704907 DOI: 10.1111/ene.15699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE The aim was to evaluate the temporal trends, characteristics and in-hospital outcomes of patients hospitalized with acute ischaemic stroke (AIS) between those with and without current or historical malignancies. METHODS Adult hospitalizations with a primary diagnosis of AIS were identified from the National Inpatient Sample database 2007-2017. Logistic regression was used to compare the differences in the utilization of AIS interventions and in-hospital outcomes. For further analysis, subgroup analyses were performed stratified by cancer subtypes. RESULTS There were 892,862 hospitalizations due to AIS, of which 108,357 (12.14%) had a concurrent diagnosis of current cancer (3.41%) or historical cancer (8.72%). After adjustment for confounders, patients with current malignancy were more likely to have worse clinical outcomes. The presence of historical cancers was not associated with an increase in poor clinical outcomes. Additionally, AIS patients with current malignancy were less likely to receive intravenous thrombolysis (adjusted odds ratio 0.66, 95% confidence interval 0.63-0.71). Amongst the subgroups of AIS patients treated with intravenous thrombolysis or mechanical thrombectomy, outcomes varied by cancer types. Notably, despite these acute stroke interventions, outcome remains poor in AIS patients with lung cancer. CONCLUSIONS Although AIS patients with malignancy generally have worse in-hospital outcomes versus those without, there were considerable variations in these outcomes according to different cancer types and the use of AIS interventions. Finally, treatment of these AIS patients with a current or historical cancer diagnosis should be individualized.
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Affiliation(s)
- Chi Peng
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Fan Yang
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University) and Key Laboratory of Tumor Immunopathology, Ministry of Education of China, Chongqing, China
| | - Liwei Peng
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Chenxu Zhang
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Zhen Lin
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Chenxin Chen
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Huachen Gao
- Department of Plastic Surgery and Burns, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jia He
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Zhichao Jin
- Department of Health Statistics, Naval Medical University, Shanghai, China
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Cancer and stroke: What do we know and where do we go? Thromb Res 2022; 219:133-140. [PMID: 36179651 DOI: 10.1016/j.thromres.2022.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
Cancer is an increasingly recognized cause for ischemic stroke, with recent acknowledgement of cancer-related stroke as an emerging stroke subtype with unique pathophysiologic mechanisms. In addition, cancer-related stroke may differ from stroke in the general population as cancer patients may not receive guideline-recommended stroke care, and the occurrence of stroke may also preclude patients from receiving optimal cancer treatments. Due to the high degree of morbidity and mortality associated with both conditions, understanding the relationship between stroke and cancer is crucial. In this narrative review, we discuss the association between cancer and stroke, the unique pathophysiologic mechanisms underlying this phenomenon, treatment options including acute reperfusion therapies and secondary prevention strategies, compare outcomes between cancer-related stroke and stroke in the general population, and review new and emerging evidence in this field.
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Chen YJ, Dong RG, Zhang MM, Sheng C, Guo PF, Sun J. Cancer-related stroke: Exploring personalized therapy strategies. Brain Behav 2022; 12:e2738. [PMID: 35938982 PMCID: PMC9480895 DOI: 10.1002/brb3.2738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cancer and ischemic stroke are two common diseases that threaten human health and have become the main causes of death in the world. It is estimated that one-in-ten patients with ischemic stroke have concomitant cancer, and this incidence is expected to increase as improvements in medical technology extends the life expectancy of cancer patients. DISCUSSION Cancer-related stroke (CRS) refers to unexplained ischemic stroke in patients with active cancer that cannot be explained by current stroke mechanisms. Available evidence suggests that CRS accounts for 5-10% of embolic stroke of undetermined source (ESUS). Although the incidence of CRS is gradually increasing, its underlying pathogenesis remains unclear. Also, there is no consensus on acute treatment and secondary prevention of stroke. CONCLUSION In this review, we retrospectively analyzed the incidence, mechanisms of CRS, its potential as a new stroke subtype, options for acute treatment, secondary prevention strategies, and disease progression, with the aim of attempting to explore personalized therapy strategies.
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Affiliation(s)
- Yu-Jie Chen
- Department of Neurological Rehabilitation, Xuzhou Central Hospital, Xuzhou city, P.R. China
| | - Rui-Guo Dong
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou city, P.R. China
| | - Meng-Meng Zhang
- Department of Neurological Rehabilitation, Xuzhou Central Hospital, Xuzhou city, P.R. China
| | - Chao Sheng
- Department of Neurological Rehabilitation, Xuzhou Central Hospital, Xuzhou city, P.R. China
| | - Peng-Fei Guo
- Department of Neurological Rehabilitation, Xuzhou Central Hospital, Xuzhou city, P.R. China
| | - Jie Sun
- Department of Neurological Rehabilitation, Xuzhou Central Hospital, Xuzhou city, P.R. China
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Garg A, Chopra S, Starr M, Rocha M, Dawod J, Leira E, Shaban A. In-Hospital Outcomes and Recurrence of Acute Ischemic Stroke in Patients With Solid Organ Malignancy. Neurology 2022; 99:e393-e401. [PMID: 35487697 DOI: 10.1212/wnl.0000000000200601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this work was to evaluate the influence of solid organ malignancies on the in-hospital outcomes and recurrent strokes among patients hospitalized with acute ischemic stroke (AIS). METHODS Adult hospitalizations with a primary diagnosis of AIS were identified from the Nationwide Readmissions Database from 2016 to 2018. Logistic regression was used to compare the differences in the use of acute stroke interventions and clinical outcomes in patients with and without malignancy. Survival analysis was used to evaluate the risk of readmission due to recurrent stroke after discharge. RESULTS There were 1,385,840 hospitalizations due to AIS (mean ± SD age 70.4 ± 14.0 years, female 50.2%). Of these, 50,553 (3.7%) had a concurrent diagnosis of solid organ malignancy. The 5 most common malignancies included lung cancer (24.6%), prostate cancer (13.2%), breast cancer (9.3%), pancreatic cancer (6.5%), and colorectal cancer (6.2%). After adjustment for baseline differences, patients with malignancy were more likely to have intraparenchymal hemorrhage (odds ratio [OR] 1.11, 95% CI 1.04-1.19), in-hospital mortality (OR 2.15, 95% CI 2.04-2.28), and discharge disposition other than to home (OR 1.70, 95% CI 1.64-1.75). Patients with malignancy were less likely to receive IV thrombolysis (tissue plasminogen activator [tPA]) and were more likely to undergo mechanical thrombectomy (MT). Among the subgroups of patients treated with tPA or MT, the outcomes were comparable between patients with and without malignancy, except patients with lung cancer remained at a higher risk of mortality and adverse disposition despite these acute stroke interventions. Patients with malignancy were at a higher risk of readmission due to recurrent AIS within 1 year of discharge (hazards ratio 1.18, 95% CI 1.11-1.25), and this risk was driven specifically by the lung and pancreatic cancers. DISCUSSION While patients with malignancy generally have worse in-hospital outcomes compared to those without, there is considerable variation in these outcomes according to the different cancer types and the use of acute stroke interventions. The use of tPA and MT is generally safe for eligible patients with an underlying malignancy. Patients with lung and pancreatic cancers have a higher early risk of recurrent stroke and might need more intensive surveillance and careful institution of the optimal secondary prevention measures.
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Affiliation(s)
- Aayushi Garg
- From the Departments of Neurology (A.G., E.L., A.S.) and Pathology (S.C.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Neurology (M.S., M.R., J.D.), University of Pittsburgh Medical Center, PA.
| | - Saurav Chopra
- From the Departments of Neurology (A.G., E.L., A.S.) and Pathology (S.C.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Neurology (M.S., M.R., J.D.), University of Pittsburgh Medical Center, PA
| | - Matthew Starr
- From the Departments of Neurology (A.G., E.L., A.S.) and Pathology (S.C.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Neurology (M.S., M.R., J.D.), University of Pittsburgh Medical Center, PA
| | - Marcelo Rocha
- From the Departments of Neurology (A.G., E.L., A.S.) and Pathology (S.C.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Neurology (M.S., M.R., J.D.), University of Pittsburgh Medical Center, PA
| | - Judy Dawod
- From the Departments of Neurology (A.G., E.L., A.S.) and Pathology (S.C.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Neurology (M.S., M.R., J.D.), University of Pittsburgh Medical Center, PA
| | - Enrique Leira
- From the Departments of Neurology (A.G., E.L., A.S.) and Pathology (S.C.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Neurology (M.S., M.R., J.D.), University of Pittsburgh Medical Center, PA
| | - Amir Shaban
- From the Departments of Neurology (A.G., E.L., A.S.) and Pathology (S.C.), University of Iowa Hospitals and Clinics, Iowa City; and Department of Neurology (M.S., M.R., J.D.), University of Pittsburgh Medical Center, PA
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Matetic A, Mohamed M, Miller RJH, Kolman L, Lopez-Mattei J, Cheung WY, Brenner DR, Van Spall HGC, Graham M, Bianco C, Mamas MA. Impact of cancer diagnosis on causes and outcomes of 5.9 million US patients with cardiovascular admissions. Int J Cardiol 2021; 341:76-83. [PMID: 34333019 DOI: 10.1016/j.ijcard.2021.07.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/11/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There are limited data on causes of cardiovascular (CV) admissions and associated outcomes among patients with different cancers. METHODS All CV admissions from the US National Inpatient Sample between October 2015 to December 2017 were stratified by cancer type as well as metastatic status. Multivariable logistic regression was performed to determine the adjusted odds ratios (aOR) of in-hospital mortality in different groups. RESULTS From 5,936,014 eligible CV admissions, cancer was present in 265,221 (4.5%) hospitalizations. There was significant variation in the admission diagnoses among the different cancers, with hematological malignancies being principally associated with heart failure (HF), lung cancer with atrial fibrillation (AF), and colorectal and prostate cancer with acute myocardial infarction (AMI). Admission with haemorrhagic stroke has the highest associated mortality across cancers (20.0-38.4%). In-hospital mortality was higher in cancer than non-cancer patients across most CV admissions (P < 0.001) with AF having the worst prognosis. Compared to group without any cancer, the greatest aOR of mortality was associated with lung cancer in AMI (aOR 2.32, 95% CI 2.18-2.47), ischemic stroke (aOR 2.21, 95%CI 2.08-2.34), AF (aOR 4.69, 95%CI 4.32-5.10) and HF (aOR 2.07, 95%CI 1.89-2.27). CONCLUSIONS The most common causes of CV admission to hospital vary in patients with different types of cancer, with AMI being most common in patients with colon cancer, HF in patients with hematological malignancies and AF in patients with lung cancer. Patients with cancer, particularly lung cancer, have greater mortality than non-cancer patients after admissions with a CV cause.
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Affiliation(s)
- Andrija Matetic
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK; Department of Cardiology, University Hospital of Split, Split, Croatia
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Louis Kolman
- Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Juan Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Winson Y Cheung
- Department of Medicine and Oncology, University of Calgary, Calgary, Canada
| | - Darren R Brenner
- Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Harriette G C Van Spall
- Division of Cardiology, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Michelle Graham
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Christopher Bianco
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK; Department of Cardiology, Thomas Jefferson University, Philadelphia, USA.
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Bondi S, Yang D, Croll L, Torres J. Patient Characteristics Associated With Readmission to 3 Neurology Services at an Urban Academic Center. Neurohospitalist 2020; 11:25-32. [PMID: 33868553 DOI: 10.1177/1941874420953320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose Hospital 30-day readmissions in patients with primary neurological problems are not well characterized. We sought to determine patient characteristics associated with readmission across 3 different inpatient neurology services at New York University Langone Hospital. Methods We retrospectively reviewed all 30-day readmissions from the General Neurology, Epilepsy, and Stroke services at NYULH Brooklyn and Manhattan campuses from 2016-2017 and compared them to a random sample of non-readmitted neurology patients. We used univariate analyses to compare demographics, clinical characteristics, disease specific metrics, and discharge factors of non-readmitted and readmitted groups and binomial logistic regression to examine specific variables with adjustment for confounders. Results We included 284 patients with 30-day readmissions and 306 control patients without readmissions matched by discharge location and service. After adjusting for confounders, we found that the following factors were associated with increased readmission risk: a recent hospital encounter increased risk for all services, increased number of medications at discharge, intensive care unit stay, higher length of stay, and prior history of seizure for the General Neurology Service, increased number of medications at discharge for the Epilepsy Service, and active malignancy and higher discharge modified Rankin Scale score for the Stroke Service. Conclusion This study identifies potential risk factors for readmission in patients across multiple neurology services. Further research is needed to establish whether these risk factors hold across multiple institutions.
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Affiliation(s)
- Steven Bondi
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Dixon Yang
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Leah Croll
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Jose Torres
- Department of Neurology, New York University Langone Health, New York, NY, USA
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Huang S, Lu X, Tang LV, Hu Y. Efficacy and safety of intravenous thrombolysis for acute ischemic stroke in cancer patients: a systemic review and meta-analysis. Am J Transl Res 2020; 12:4795-4806. [PMID: 32913551 PMCID: PMC7476124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
The efficacy and safety of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) in cancer patients remained uncertain due to low level evidence in the latest guideline for AIS. The aim of this study was to assess the efficacy and safety of IVT in cancer patients with stronger evidence. We searched Medline, Embase, CENTRAL and ClinicalTrials.gov until April 2020 for studies reporting outcomes of functional independence, hemorrhagic transformation (HT), symptomatic intracranial hemorrhage (SICH), major bleeding (MB), in-hospital mortality or 3-month mortality after IVT for AIS in cancer patients. For each outcome, the odds ratio between cancer and non-cancer patients, the risk difference between gastrointestinal and other malignancy, and the proportion in cancer patients were calculated. The meta-analysis showed no significant difference between cancer and non-cancer patients in favorable outcome, HT, SICH, MB, in-hospital mortality and 3-month mortality. Furthermore, there's no significant difference between patients with gastrointestinal and other malignancy in favorable outcome, HT, SICH, MB and 3-month mortality. In race-based subgroup analysis, Asians implied greater likelihood of HT and SICH than non-Asians. Therefore, the study confirmed and strengthened the validity of the guideline with stronger evidence that cancer shouldn't be an exclusion criterion of IVT. Inconsistent with the guideline, gastrointestinal malignancy may not remain an absolute contraindication of IVT while Asians implied increased HT and SICH, which needed further exploration.
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Affiliation(s)
- Sui Huang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei, China
| | - Xuan Lu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei, China
| | - Liang V Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei, China
- Collaborative Innovation Center of Hematology, Huazhong University of Science and TechnologyWuhan, Hubei, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei, China
- Collaborative Innovation Center of Hematology, Huazhong University of Science and TechnologyWuhan, Hubei, China
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Chen Y, Zhang C, Wang X, Han L, Zhu S, Liu Y, Wang R, Geng Z, Ma C, Dong R. Suitability of Thrombolysis for Patients With Acute Ischemic Stroke Complicated With Trousseau Syndrome. Front Neurosci 2020; 14:481. [PMID: 32595439 PMCID: PMC7303462 DOI: 10.3389/fnins.2020.00481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
Intravenous thrombolysis (IVT) improves functional outcome after acute ischemic stroke (AIS) and is the standard first-line treatment; however, it is associated with many complications, including cerebral hemorrhage. Cancer patients are susceptible to thrombotic events – collectively referred to as Trousseau syndrome (TS) – owing to their hypercoagulable state. Here, we describe the case of a 55-year-old male with a history of hypertension for over 10 years who underwent surgery for removal of a cancer of lower esophagus, with no subsequent treatment. Three months later, he was admitted to the emergency department of our hospital with sudden dizziness and incoherent speech. Brain computed tomography revealed multiple cerebral infarctions. The patient was treated by IVT with tissue plasminogen activator (rtPA) after the onset of symptoms, which improved by the end of the treatment. However, a few months later, he experienced a recurrence of cerebral infarction and hemorrhage, which has rarely been reported. The clinical course of this case suggests that the suitability of thrombolysis with rtPA in the acute phase of cerebral infarction complicated with TS should be carefully considered.
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Affiliation(s)
- Yujie Chen
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chundi Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xin Wang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Long Han
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Shiguang Zhu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yan Liu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Rui Wang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ziyang Geng
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chenchen Ma
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ruiguo Dong
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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