Mechanical Thrombectomy in Patients with Malignancy: Comparable Procedural Success but Less Favorable Long-Term Outcomes

Background and Aims: Patients with malignancy are frequently excluded from randomized thrombectomy trials, and evidence regarding the safety and efficacy of mechanical thrombectomy (MT) in this population remains incompletely defined. We aimed to compare procedural success, functional outcomes, and mortality between acute ischemic stroke (AIS) patients with and without malignancy undergoing MT. Methods: We retrospectively analyzed 110 patients treated with MT. Patients were stratified into two groups: those with malignancy (n = 48) and those without malignancy (n = 62). Baseline demographics, vascular risk factors, procedural metrics, angiographic outcomes, and clinical outcomes including functional independence (modified Rankin Scale mRS 0–2), 90-day mortality and intracranial hemorrhage were compared. Results: Baseline demographics and admission stroke severity were similar between groups. Smoking was significantly more frequent in the malignancy group (25% vs. 11.3%, p < 0.001). Successful reperfusion (TICI 2b-3) was achieved in 95.8% of malignancy patients and 98.4% of controls (p = 0.51). Functional independence at 90 days was lower in the malignancy group (42.6% vs. 61.3%, p = 0.04), whereas 90-day mortality was significantly higher (44.7% vs. 19.4%, p = 0.004); this increase in mortality remained significant after multivariate analysis. There were no significant differences in rates of intracranial hemorrhage between groups (p = 0.53). Conclusions: Mechanical thrombectomy is technically effective and safe in patients with malignancy; however, long-term functional recovery and survival are significantly worse, likely reflecting the effect of cancer itself rather than procedural factors. Careful patient selection and multidisciplinary decision-making are essential in this population.