Early functional outcomes after mechanical thrombectomy in patients with large vessel occlusion and active cancer

Evaluating mechanical thrombectomy (MT) in patients with large vessel occlusion stroke (LVOS) and active cancer (AC) is challenging because cancer-related mortality substantially affects conventional functional outcomes. This study aimed to assess the association between MT and early functional outcomes while minimizing the confounding impact of cancer-related death.

We retrospectively reviewed patients with LVOS and AC between January 2016 and December 2024. Patients were categorized into MT and non-MT groups. The primary outcome was the distribution of modified Rankin Scale (mRS) scores at 2 weeks, analyzed using ordinal logistic regression. A sensitivity analysis excluding patients who died from cancer progression within 2 weeks of stroke onset was also performed. LVOS was defined as ischemic stroke with occlusion of the intra- or extracranial internal carotid artery, middle cerebral artery (M1 or M2 segments), or basilar artery.

Among 72 patients with LVOS and AC (median age, 76 years; 36 women), 32 (44%) underwent MT (28 MT alone, and 4 MT procedures combined with intravenous thrombolysis), whereas 3 patients in the non-MT group received intravenous thrombolysis alone. At 2 weeks, MT was significantly associated with a favorable shift in mRS distribution (adjusted odds ratio [OR] 3.48, 95% confidence interval [CI] 1.22-9.97; p = 0.020). In a sensitivity analysis excluding cancer-related deaths, this association remained significant, with a larger effect size (adjusted OR, 6.21, 95% CI, 1.89-20.47; p = 0.003).

MT was associated with improved early functional outcomes in patients with LVOS and AC.