Key result
Active cancer is linked to ~173% greater odds of multiple infarctions in cryptogenic stroke.
Why the study?
Although active cancer causes ischemic stroke through conditions like Trousseau syndrome, the relationship between stroke and inactive cancer was poorly understood.
Do active and inactive cancer statuses have different underlying pathogeneses and atherosclerotic embolic sources in patients with cryptogenic stroke?
Observational (n=667)
Yes
Do active and inactive cancer statuses have different underlying pathogeneses and atherosclerotic embolic sources in patients with cryptogenic stroke?
In patients with cryptogenic stroke, active cancer is associated with multiple infarctions, while inactive cancer is associated with atherosclerotic embolic sources.
Cancer status may guide embolic source evaluation in cryptogenic stroke; leaves open whether secondary prevention should differ by active versus inactive disease.
Background Cerebrovascular diseases are common comorbidities in patients with cancer. Although active cancer causes ischemic stroke by multiple pathological conditions, including thromboembolism attributable to Trousseau syndrome, the relationship between stroke and inactive cancer is poorly known. The aim of this study was to elucidate the different underlying pathogeneses of cryptogenic stroke in active and inactive patients with cancer, with detailed investigation by transesophageal echocardiography. Methods and Results CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for Embolic Stroke of Undetermined Source/Cryptogenic Stroke) registry is a multicenter registry including data of patients initially diagnosed as having cryptogenic stroke and undergoing transesophageal echocardiography. Patients were divided into active cancer, inactive cancer, and noncancer groups, and their clinical features were compared. Of the total 667 enrolled patients (age, 68.7±12.8 years; 455 men), 41 (6.1%) had active cancer, and 51 (7.5%) had a history of inactive cancer. On multinomial logistic regression analysis, infarctions in multiple vascular territories (odds ratio [OR], 2.73; 95% CI, 1.39-5.40) and CRP (C-reactive protein) (OR, 1.10; 95% CI, 1.01-1.19) were independently associated with active cancer, whereas age (OR, 1.05; 95% CI, 1.01-1.08), contralateral carotid stenosis from the index stroke lesion (OR, 4.05; 95% CI, 1.60-10.27), calcification of the aortic valve (OR, 2.10; 95% CI, 1.09-4.05), and complicated lesion of the aortic arch (OR, 2.13; 95% CI, 1.11-4.10) were significantly associated with inactive cancer. Conclusions Patients with cancer were not rare in cryptogenic stroke. Although patients with active cancer had more multiple infarctions, patients with inactive cancer had more atherosclerotic embolic sources potentially causing arteriogenic strokes. Registration URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000032957.
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A 2021 study conducted an observational in Cryptogenic stroke (n=667). Active cancer vs. Inactive cancer and noncancer was evaluated on Infarctions in multiple vascular territories (OR 2.73, 95% CI 1.39-5.40). In patients with cryptogenic stroke, active cancer was associated with multiple infarctions (OR 2.73; 95% CI 1.39-5.40), while inactive cancer was associated with atherosclerotic embolic sources.
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