Endovascular thrombectomy versus medical management for large vessel occlusion stroke patients with brain malignancy

High-quality evidence supports endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke, but its safety and efficacy for patients with brain malignancy are not well studied. This study explores the safety and efficacy of EVT for LVO stroke patients with brain malignancy.

This was a retrospective cohort study of the 2016-2022 Nationwide Readmissions Database. Adult patients with LVO stroke (internal carotid, middle cerebral, or basilar artery occlusion), an NIH stroke scale of at least 6, and brain malignancy were included. Patients who underwent EVT were compared to those who underwent best medical management (BMM). The primary outcome was functional independence at time of hospital discharge. Secondary outcomes included hemorrhagic complications, hospital length of stay (LOS), and death.

A total of 1483 LVO patients were included, 410 received EVT. After multivariable adjustments, EVT patients had significantly higher rates and odds of functional independence (16.6% vs. 7.9%, p=0.001; adjusted OR 4.00 [95%CI 2.10 to 7.46] p<0.001). EVT was associated with higher rates of intraparenchymal hemorrhage in unadjusted analyses (21.5% vs. 13.3%, p=0.018) and continued to trend towards statistical significance after multivariable adjustments (aOR 1.60 [95%CI 0.95-2.68], p=0.08). EVT was significantly associated with higher rates and odds of subarachnoid hemorrhage, before and after multivariable adjustments (11.5% vs. 1.5%, p<0.001; aOR 12.9 [95%CI 4.66-35.86], p<0.001). EVT was not associated with differences in LOS and mortality (p>0.05 for both).

EVT was associated with increased functional independence despite increased risk of hemorrhagic complications, without increasing lengths of hospital stay or mortality.