{
  "abstract": "Background The optimal first-line device choice for endovascular treatment (EVT) of cancer-related stroke (CRS) remains largely unknown.Aim of Study We evaluated the efficacy and safety of the EVT methods for treating CRS thrombi.Methods We retrospectively analyzed 78 CRS patients who underwent EVT between February 2011 and July 2024. Patients were compared based on the first-line EVT technique (combined [n=29] vs stent retriever (SR) only [n=35] vs contact aspiration [CA, n=14]) and the type of the SR (the dual-layered stent retriever [DLSR; Embotrap] [n=13], the single-layered stent retrievers (SLSR; Trevo [n=16] and the Solitaire [n=35]) group. The primary efficacy outcome was first pass effect (FPE, achieving modified Thrombolysis in Cerebral Infarction [mTICI] score of 2c or 3 after first pass). The primary safety outcome was symptomatic intracranial hemorrhage (sICH).Results FPE was comparable between the first-line EVT techniques (combined 34.5% vs SR only 17.1% vs CA 35.7%; P=0.2). Among the SR groups, the DLSR showed a higher FPE rate compared to the SLSR (Trevo) and the SLSR (Solitaire) (53.8% vs 25.0% vs 14.3%, P=0.023). The DLSR was independently associated with a higher FPE rate (adjusted odds ratio, 11.0 [95% CI 1.4-126.0]; P=0.031). The incidence of sICH after procedure was not significantly different between the groups.Abstract LB1 Figure 1Cancer related white thrombus captured by the dual-cage and distal mesh structure of dual-layered stent retrieverA 24-year-old male with underlying metastatic cardiac sarcoma presented with acute onset left side weakness and underwent emergent endovascular thrombectomy. A) Right distal ICA occlusion was noted on DSA. B) Complete recanalization was achieved. C) Notice the white clot trapped between the outer (single arrow) and the inner (double arrows) cages and the distal mesh (thick arrow) of the dual-layered stent retriever. D) Immunohistochemical staining demonstrates the distribution of fibrin (left), platelets (middle), and red blood cells (RBC, right). The thrombus was composed predominantly of platelet/fibrin-rich material (40%) with a low RBC content (9%). Although the patient showed marked improvement of the neurological symptoms (initial/7day NIHSS scores of 17/0) the patient died about 40 days later due to symptoms of heart failureAbstract LB1 Table 1Multivariable analysis for treatment outcomes DLSR(n=13) SLSR [Trevo](n=16) Solitaire (n=35) aOR or B (95% CI) P aOR or B (95% CI) P Primary efficacy outcomes  First pass effect11.0 (1.4 to 126.0)0.033.1 (0.5 to 20.8)0.2Ref Secondary outcomes  SRTNA>0.95.8 (0.8 to 86.9)0.13Ref Complete reperfusion6.8 (1.3 to 47.1)0.032.5 (0.5 to 12.3)0.3Ref Successful reperfusionNA>0.91.0 (0.2 to 5.6)>0.9Ref Total number of passes-29 (-61 to 2.8)0.07-17 (-45 to 11)0.2Ref Procedure time, min-26 (-58 to 5.4)0.10-15 (-43 to 14)0.3Ref Any ICH0.43 (0.1 to 2.2)0.32.4 (0.6 to 11.6)0.2Ref Primary safety outcome  Symptomatic ICHNA>0.92.6 (0.5 to 18.2)0.3Ref Clinical outcomes  Functional independence1.5 (0.2 to 12.1)0.71.0 (0.1 to 7.3)>0.9Ref Mortality at 3 months1.1 (0.2 to 6.3)>0.90.4 (0.1 to 1.4)0.14RefAdjusted values were age, sex, intravenous tissue plasminogen use, interval from onset to puncture, NIHSS score before endovascular thrombectomy and occlusion site. aOR, adjusted odds ratio; B, beta coefficient; SRT, Successful Reperfusion within Three passes; NA, non-applicable; ICH, intracranial hemorrhage.Conclusion In EVT for CRS the dual-layered SR device demonstrated better efficacy in achieving higher rate of first pass effect without elevating the sICH rate. These findings suggest that the dual-layered SR may be preferred as the first-line treatment option for EVT in CRS.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea",
        "Department of Radiology, Yonsei University College of Medicine, Seoul, Korea"
      ],
      "name": "Jaeseob Yun"
    },
    {
      "affiliations": [
        "Department of Radiology, Yonsei University College of Medicine, Seoul, Korea",
        "Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea"
      ],
      "name": "Kwang Hyun Kim"
    },
    {
      "affiliations": [
        "Department of Radiology, Yonsei University College of Medicine, Seoul, Korea",
        "Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea"
      ],
      "name": "Solbi Kim"
    },
    {
      "affiliations": [
        "Department of Radiology, Yonsei University College of Medicine, Seoul, Korea",
        "Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea"
      ],
      "name": "Kyu Seon Chung"
    },
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea"
      ],
      "name": "Hyo Suk Nam"
    },
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea",
        "Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea"
      ],
      "name": "Ji Hoe Heo"
    },
    {
      "affiliations": [
        "Department of Radiology, Yonsei University College of Medicine, Seoul, Korea"
      ],
      "name": "Byung Moon Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea"
      ],
      "name": "Young Dae Kim"
    },
    {
      "affiliations": [
        "Department of Radiology, Yonsei University College of Medicine, Seoul, Korea"
      ],
      "name": "Dong Joon Kim"
    }
  ],
  "title": "LB1 Endovascular thrombectomy in cancer-related stroke: comparison of thrombectomy methods",
  "uid": "5251c3ec-5a76-56e3-9e0b-607cda6de3c6"
}