Early functional outcomes after mechanical thrombectomy in patients with large vessel occlusion and active cancer

BACKGROUND: Evaluating mechanical thrombectomy (MT) in patients with large vessel occlusion stroke (LVOS) and active cancer (AC) is challenging because cancer-related mortality substantially affects conventional functional outcomes. This study aimed to assess the association between MT and early functional outcomes while minimizing the confounding impact of cancer-related death. METHODS: We retrospectively reviewed patients with LVOS and AC between January 2016 and December 2024. Patients were categorized into MT and non-MT groups. The primary outcome was the distribution of modified Rankin Scale (mRS) scores at 2 weeks, analyzed using ordinal logistic regression. A sensitivity analysis excluding patients who died from cancer progression within 2 weeks of stroke onset was also performed. LVOS was defined as ischemic stroke with occlusion of the intra- or extracranial internal carotid artery, middle cerebral artery (M1 or M2 segments), or basilar artery. RESULTS: Among 72 patients with LVOS and AC (median age, 76 years; 36 women), 32 (44%) underwent MT (28 MT alone, and 4 MT procedures combined with intravenous thrombolysis), whereas 3 patients in the non-MT group received intravenous thrombolysis alone. At 2 weeks, MT was significantly associated with a favorable shift in mRS distribution (adjusted odds ratio [OR] 3.48, 95% confidence interval [CI] 1.22-9.97; p = 0.020). In a sensitivity analysis excluding cancer-related deaths, this association remained significant, with a larger effect size (adjusted OR, 6.21, 95% CI, 1.89-20.47; p = 0.003). CONCLUSION: MT was associated with improved early functional outcomes in patients with LVOS and AC.