Features of clinical manifestations of ischemic stroke in cancer

Determination of clinical characteristics of ischemic stroke (IS) in cancer patients is difficult due to the involvement of both traditional and cancer-associated mechanisms in stroke pathogenesis. To date, there are no clear diagnostic criteria for cancer-associated stroke, which is often one of the first clinical manifestations of the oncological process.

 The aim of the study — to research the clinical manifestations of ischemic stroke associated with cancer.

 Material and methods. A comparative analysis of 84 cases of IS with concomitant cancer (main group) and 239 cases of IS without cancer (comparison group) was performed. All patients were assessed for the severity of IS according to the NIHSS scale, stroke subtype according to TOAST, disease outcome, localization and size of the cerebral infarction territory according to neuroimaging data; presence of hemorrhagic transformation. The parameters of coagulation hemostasis (international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin index (PTI), fibrinogen, platelet count) were assessed at the time of admission to the hospital. The follow-up of patients in the main group was studied based on the data from outpatient cards in the RTMIS system, using a telephone survey of patients and their relatives 3 months and 1 year after the stroke.

Results. During the observation period, 2027 patients with ischemic stroke were hospitalized, of which 84 patients (the main group) were diagnosed with active stage cancer (4.14%). In the main group, 20 patients (23.8%) were diagnosed with cancer during hospitalization at the Regional Vascular Center due to ischemic stroke. The most common localization in the study group was colon cancer (19.04%). Lung cancer was diagnosed in 13.1%, bladder cancer — in 10.7%. According to the histological type, adenocarcinomas were most often detected — in 35 cases (41.6%). The median age in the main group was 69 years [65;75], in the comparison group — 65 years [58;72] (p < 0.001). In the main group of diseases, large-artery atherosclerosis (14.3% vs. 43.1%, respectively, p < 0.001) and cardioembolic stroke subtypes (14.3% vs. 30.5%, respectively, p = 0.004) were diagnosed less frequently. In the main group, there was a more frequent diagnosis of the IS subtype of other determined etiology (13.1% vs. 3.8%, respectively; p = 0.003) and of undetermined etiology according to TOAST (47.6% vs. 8.8%, respectively; p < 0.001). In the main group, in patients, compared with the consequence without cancer, multifocal infarctions that developed simultaneously in both carotid basins were more often diagnosed (9.5% vs. 2.5%, respectively, p = 0.011; OR = 4.09, 95% CI: 1.37–12.15). Upon admission to the hospital, the PTI values were higher in the main group of patients compared to patients without cancer (102.5 [84.0; 111.0] versus 87.7 [72.4; 99.0], p = 0.003). In patients with ischemic stroke, who were diagnosed with cancer in the RVC, higher fibrinogen and platelet levels were noted (p = 0.022 and p = 0.008). Mortality within 3 months after the suffered ischemic stroke in the group was 21.4% (18 patients), within a year — 42.9% (36 patients).

Conclusion. Cancer-associated coagulopathy probably plays a leading role in the development of ischemic stroke in cancer.

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