Abstract Body: Introduction: Comorbid active cancer among in-hospital onset acute ischemic stroke (IHS) is increasing. We aimed to clarify the differences in the initial management and clinical outcome of IHS patients between with and without active cancer.
Methods: During the period from August 2016 to July 2023, 200 IHS patients (58% male, median age 78 years, median NIHSS score 9) at a single institution were divided into two groups: 70 IHS patients with active cancer (IHS-AC group, 35%) and 130 IHS patients without active cancer (IHS-nonAC group, 65%). Patients’ characteristics, time course, of initial management and clinical outcome were compared in both groups. A good functional outcome was defined as modified Rankin Scale score 0-3. AC was defined as diagnosis of cancer within 6 months of stroke onset, any treatment for cancer within the previous 6 months, or recurrent or metastatic cancer.
Results: IHS was identified most frequently by a nurse in both groups (67% in the IHS-AC group and 71% in the IHS-nonAC group). The time from last known well to recognition (median, 112 min vs. 165 min, p=0.178) and time from recognition to stroke physician assessment (37 min vs. 90 min, p=0.008) were shorter in the IHS-AC group than the IHS-nonAC group. Good functional outcome at discharge (31% in each group, p=1.000) and the in-hospital mortality (29% in the IHS-AC group, 21% in the IHS-nonAC group, p=0.225) were similar in both groups. The rates of reperfusion therapy (intravenous rt-PA and/or mechanical thrombectomy) were 16% in the IHS-AC group and 15% in the IHS-nonAC group, with no significant difference (p=1.000). The rates of good functional outcome and mortality at discharge in patients with reperfusion therapy were 36%, respectively.
Conclusion: One-third of IHS were comorbid active cancer. The rates of reperfusion therapy and good functional outcome were similar in both groups. Because one-third of IHS-AC patients with reperfusion therapy regained independent gait, acute stroke management for IHS should not be withheld solely based on cancer.