Patterns and predictors of cancer-associated ischemic stroke

Objectives: Cancer-associated stroke (CAS) represents a unique ischemic stroke subtype with distinct mechanisms and poor prognosis. Our study aimed to evaluate CAS patient demographics, stroke patterns, and prognostic factors with a focus on the role of D-dimer levels and multi-vascular territorial infarctions (MVTI) among patients with CAS. Materials and Methods: We conducted a retrospective analysis of 54 CAS patients admitted between 2014 and 2024 at a tertiary care center in India. Clinical, imaging, and biomarker data were collected, and stroke subtypes, functional outcomes modified Rankin scale (mRS), and survival at 3 months were analyzed. Results: The median patient age was 58 (46–70) years, with women comprising 52% of the cohort. Gynecological and hepatobiliary cancers (18.5% each) were the most prevalent, and 25% of patients had metastatic disease. Mean D-dimer level was 5.1 ± 4.4 µg/mL, and MVTI was observed in 42% which was strongly associated with cryptogenic strokes (62%). Poor outcomes (mRS 5–6) were observed in 53% of patients, with a 3-month mortality rate of 44%. Stroke recurrence occurred in 8% (predominantly in patients with MVTI and elevated D-dimer levels) and revealed an occult cancer in two cases. Conclusion: Elevated D-dimer and MVTI are key markers in CAS, which help in both diagnosis and prognosis. Future research is needed for treatment strategies, particularly anticoagulation in CAS.