Endovascular Thrombectomy in Patients With Cancer and Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract

Patients with cancer and acute ischemic stroke are underrepresented in randomized thrombectomy trials, and the safety and effectiveness of endovascular thrombectomy (EVT) in this population remain uncertain. We systematically reviewed clinical, procedural, and safety outcomes of EVT in cancer patients compared to non-cancer controls. Searches of PubMed, Scopus, and the Cochrane Library identified 10 observational studies. Meta-analyses summarized outcomes within cancer groups, while comparative analyses calculated risk differences (RDs) as cancer minus control. Bias was assessed using the ROBINS-I (Risk of Bias In Non-randomized Studies of Interventions) tool. Among cancer patients undergoing EVT, the pooled success rate for recanalization was 77.1% (95% CI, 71.2%-83.0%). Symptomatic intracranial hemorrhage (sICH) occurred in 4.5% (95% CI, 2.6%-6.5%). A favorable 90-day functional outcome (modified Rankin Scale (mRS) ≤2) was seen in 26.8% (95% CI, 20.6%-32.9%), with 39.4% (95% CI, 31.6%-47.2%) dying within 90 days. Comparative analyses showed that cancer patients were significantly less likely to attain mRS ≤2 at 90 days (RD, -0.170; 95% CI, -0.223 to -0.116; I² = 23.4%) and had higher 90-day mortality (RD, 0.234; 95% CI, 0.168 to 0.300; I² = 45.1%). No significant differences were found for successful recanalization (RD, -0.033; 95% CI, -0.083 to 0.016; I² = 31.5%) or sICH (RD, -0.001; 95% CI, -0.020 to 0.018; I² = 0%). Sensitivity analyses excluding high-bias studies produced similar results. EVT can yield high recanalization rates with low sICH risk in cancer patients; however, they show poorer functional recovery and higher 90-day mortality than controls. These results emphasize the need for personalized treatment considering both stroke and cancer prognosis.