Endovascular Thrombectomy in Cancer-Related Stroke: Comparison of Thrombectomy Methods

Abstract

BACKGROUND The optimal first-line device choice for endovascular treatment (EVT) of cancer-related stroke remains largely unknown. In this study, we evaluated the efficacy and safety of the EVT methods for treating cancer-related stroke thrombi.METHODS We retrospectively analyzed 78 patients with cancer-related stroke who underwent EVT between February 2011 and July 2024. Patients were compared based on the first-line EVT technique (combined [n = 29] versus stent retriever [SR] only [n = 35] versus contact aspiration [CA, n = 14]) and the type of the SR (the dual-layered stent retriever [Embotrap] [n = 13], the single-layered stent retriever (Trevo [n = 16], and the Solitaire [n = 35]) group. The primary efficacy end point was the first-pass effect (achieving a modified Thrombolysis in Cerebral Infarction score of 2c or 3 after the first pass). The primary safety end point was the symptomatic intracranial hemorrhage rate.RESULTS The primary efficacy did not differ between the first-line EVT techniques (first-pass effect: combined 34.5% versus SR only 17.1% versus CA 35.7%; P = 0.2). Among the SR groups, the dual-layered stent retriever group showed a higher rate of first-pass effect compared with the single-layered stent retriever (Trevo) and the single-layered stent retriever (Solitaire) groups (53.8% versus 25.0% versus 14.3%, P = 0.023). The dual-layered stent retriever group was independently associated with a higher rate of first pass effect (adjusted odds ratio, 11.0 [95% CI 1.4-126.0]; P = 0.031). The incidence of symptomatic intracranial hemorrhage after the procedure did not significantly differ between the groups.CONCLUSIONS In EVT for cancer-related stroke, the dual-layered stent retriever device demonstrated superior efficacy in higher rates of first-pass effect without increasing the risk of symptomatic intracranial hemorrhage. These findings suggest that the dual-layered SR may be preferred as the first-line treatment option for EVT in cancer-related stroke.