{
  "abstract": "Background Endovascular thrombectomy (EVT) in large vessel occlusion (LVO) with active cancer remains uncertain due to poor outcomes. This retrospective cohort study aimed to identify predictors of (1) early post-stroke death and death despite successful recanalization (SR) and (2) favorable outcomes among survivors.Methods We analyzed 153 patients with active cancer and EVT-eligible LVO from four tertiary stroke centers (2017–2024). We performed an exploratory 1:1 propensity score-matched comparison of EVT versus non-EVT management, as well as separate analyses of the EVT-treated cohort. The primary outcome was death within 3 months despite SR (modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3), while secondary outcomes included early post-stroke death and favorable functional outcome among 3-month survivors.Results Propensity score matching (PSM) yielded a 1:1 matched cohort (non-EVT, n=30; EVT, n=30) with improved, though not perfect, covariate balance. In this exploratory matched cohort, EVT showed only a non-significant trend toward favorable outcome and was not associated with lower mortality. In the EVT-treated cohort, systemic metastasis and elevated D-dimer predicted early mortality. Among patients with SR, death despite SR occurred in 43% (37/86) and was associated with systemic metastasis and elevated D-dimer rather than procedural factors. Among 3-month EVT survivors, first-pass effect (FPE) was the only procedural factor independently associated with favorable functional outcome.Conclusions In cancer-related LVO, EVT decisions should consider the risk of death despite SR based on metastasis and hypercoagulability. For patients with survival potential, achieving FPE is critical for favorable outcomes.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (the Republic of)"
      ],
      "name": "Hyung Jun Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (the Republic of)"
      ],
      "name": "Jong-Won Chung"
    },
    {
      "affiliations": [
        "Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea (the Republic of)",
        "Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Korea (the Republic of)"
      ],
      "name": "Tae-Jin Song"
    },
    {
      "affiliations": [
        "Department of Neurology, Ajou University School of Medicine, Suwon, Korea (the Republic of)"
      ],
      "name": "Jin-Soo Lee"
    },
    {
      "affiliations": [
        "Department of Neurology, Calgary University College of Medicine, Calgary, Alberta, Canada",
        "Division of Neurology, Stanford University Hospital, Palo Alto, California, USA"
      ],
      "name": "Ronda Lun"
    },
    {
      "affiliations": [
        "Division of Neurology, Stanford University Hospital, Palo Alto, California, USA"
      ],
      "name": "Parshva Shah"
    },
    {
      "affiliations": [
        "Division of Neurology, Stanford University Hospital, Palo Alto, California, USA",
        "Interventional Radiology, Stanford University School of Medicine, Palo Alto, California, USA"
      ],
      "name": "Aroosa Zamarud"
    },
    {
      "affiliations": [
        "Division of Neurology, Stanford University Hospital, Palo Alto, California, USA"
      ],
      "name": "Gregory W Albers"
    },
    {
      "affiliations": [
        "Division of Neurology, Stanford University Hospital, Palo Alto, California, USA",
        "Division of Neurology, Mass General Brigham, Boston, Massachusetts, USA"
      ],
      "name": "Benjamin Teasdale"
    },
    {
      "affiliations": [
        "Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (the Republic of)"
      ],
      "name": "Keon-Ha Kim"
    },
    {
      "affiliations": [
        "Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (the Republic of)"
      ],
      "name": "Wook Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (the Republic of)"
      ],
      "name": "Woo-Keun Seo"
    },
    {
      "affiliations": [
        "Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (the Republic of)"
      ],
      "name": "Pyoung Jeon"
    },
    {
      "affiliations": [
        "Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (the Republic of)"
      ],
      "name": "Gyeong-Moon Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea (the Republic of)"
      ],
      "name": "Oh Young Bang"
    }
  ],
  "title": "Refining endovascular thrombectomy for large vessel occlusion in active cancer: predictors of death despite successful recanalization",
  "uid": "99175533-3d40-5b2a-bce2-a8005ab5e4ee"
}