Clinical Study Of Cancer-associated Ischemic Stroke

Objectives:We aimed to explore the risk factors,biomarkers,etiology,and neuroimaging characteristics in patients with ischemic stroke and active cancer.Methods:This retrospective study enrolled consecutive adult patients with acute ischemic stroke admitted to our department between December 2017 and January 2019.The patients were divided into ischemic stroke with active cancer(cancer group,N=53)and ischemic stroke without cancer(control group,N=746).The sociodemographic data,vascular risk factors,National Institutes of Health Stroke Scale(NIHSS)scores on admission;the serum levels of platelet count,hemoglobin,fibrinogen,D-dimer and C-reactive protein(CRP);diffusion-weighted imaging(DWI)showing acute multiple ischemic lesions located in more than one vascular territories(AMIMCT);and the type,histology and stage of cancer were recorded.Univariate and multivariate stepwise Logistic regression analysis were used to analyze the risk factors of cancer-associated ischemic stroke.Results:Compared with control group,patients in cancer group had older age(t=3.00,P<0.01),lower proportion of hyperlipidemia(?~2=14.13,P<0.01).Patients in cancer group had lower proportion of large artery atherosclerosis(LAA;?~2=53.80,P<0.01),but higher proportion of stroke of undetermined etiology(SUE;?~2=250.60,P<0.01).All of the average NIHSS score at admission(t=2.89,P<0.01),proportion of AMIMCT(?~2=38.63,P<0.01),and the incidence of deep vein thrombosis or pulmonary embolism during hospitalization(?~2=10.56,P<0.01)in the cancer group were higher than those of the control group.Patients with active cancer had significantly higher serum levels of fibrinogen(t=3.49,P<0.01),D-dimer(Z=-9.55,P<0.01),and CRP(Z=-7.3,P<0.01),but lower levels of hemoglobin(t=-6.63,P<0.01),than those in the control group.Multivariate Logistic regression analysis showed lack of history of hyperlipidemia(odds ratio[OR]=0.17,95%confidence interval[CI]:0.06–0.48,P<0.01),undetermined etiology(OR=22.87,95%CI:9.91–52.78,P<0.01)and elevated serum fibrinogen(OR=1.72,95%CI:1.33–2.22,P<0.01)and D-dimer(OR=1.43,95%CI:1.24–1.64,P<0.01)were risk factors for cancer-associated ischemic stroke.Conclusions:It is usually lack of evidence of LAA for cancer-associated ischemic stroke.Elevated secrum fibrinogen and D-dimer,and undetermined etiology demonstrated that hypercoagulability and microembolus embolism might be the possible mechanism of cancer-associated ischemic stroke.