Cerebrovascular and Peripheral Vascular Complications in Cancer Patients

This review explores the complex relationship between cancer and vascular disease. It aims to synthesize current evidence on the epidemiology, mechanisms, management, and outcomes of ischemic stroke, cerebral venous sinus thrombosis (CVST), venous thromboembolism (VTE) in brain tumor patients, and intracranial hemorrhage (ICH), while highlighting the cerebrovascular risks of systemic cancer therapies.

Recent studies reveal that cancer patients are at increased risk for ischemic stroke, often from cancer-specific mechanisms such as hypercoagulability, non-bacterial thrombotic endocarditis, and tumor embolism. VTE is increasingly recognized in patients with primary brain tumors. Emerging data support the safety of direct oral anticoagulants over low-molecular weight heparin in selected patients with brain tumors. Cancer treatments-including immune checkpoint inhibitors (ICIs), hormonal therapies, and radiation-contribute to cerebrovascular risk. Vascular complications are underrecognized yet significant contributors to morbidity and mortality in cancer patients. Multidisciplinary strategies, personalized risk stratification, and targeted research are critical to improving outcomes in this vulnerable population.