Abstract Body: Background: Head and neck cancer (HNC) survivors have more than double the risk of ischemic stroke relative to the general population, attributed to radiation-induced carotid vasculopathy. Yet the characteristics of large vessel occlusion (LVO) stroke in HNC survivors is undefined. This study aimed to characterize LVO strokes among HNC survivors who received endovascular therapy (EVT).
Methods: Retrospective analysis of a single-center prospective stroke registry of EVT patients from January 2021 to January 2024. Patients were divided into three groups: HNC, other cancer (other-CA) and no cancer (non-CA). Demographic data, clinical characteristics, and procedural variables were compared between groups. Primary outcomes were functional independence (modified Rankin Scale [mRS] 0-2) and mortality at 90 days. Multivariable binary and multinominal logistic analyses were performed to adjust for baseline imbalances.
Results: Among 1004 patients undergoing EVT in this cohort, 884 (88.0%) were non-CA, 110 (11.0%) had other-CA, and 10 (1.0%) had HNC status post neck radiation therapy. The median [IQR] age of HNC patients were significantly younger (63.5 years [IQR: 61.3–69]), compared to both non-CA and other-CA groups (72 years [IQR: 61–80] and 73.5 years [IQR: 65–82], respectively), p = 0.02. The prevalence of tandem carotid occlusion requiring angioplasty or stenting was 90% in the HNC group, whereas it was 15.3% in non-CA and 10.8% in other-CA groups (adjusted odd ratio (aOR) 48.7, 95% CI [8.1 – 830], p=<0.001). HNC patients were less likely to achieve complete reperfusion compared to the other 2 groups (40.0 % vs 48.5 % vs 61.8 %; aOR 1.6, 95% CI [1.09 – 2.4], p=0.01). The rate of mRS 0-2 at 90 days was 55.5% in the HNC group, compared to the 33.4% in non-CA or 32.2% in other-CA, which did not reach statistical significance (p = 0.4). There was no statistically significant difference in the age-adjusted mortality rate at 90 days among the 3 groups.
Conclusion:
HNC survivors with LVO stroke referred for EVT were younger but had extremely high prevalence of tandem carotid occlusion requiring angioplasty and stenting. They experienced comparable rates of functional outcomes and mortality, despite lower rates of complete reperfusion relative to non-HNC groups. The findings support the need for early monitoring and prevention for accelerated carotid vasculopathy in this population.