Clinical study of cancer-associated ischemic stroke

Abstract

Objective To explore the influencing factors, biomarkers, etiology and imaging features of cancer-associated ischemic stroke. Methods The clinical data of 693 patients with ischemic stroke from April 2018 to January 2019 were retrospectively collected. The patients were divided into ischemic stroke with active cancer (cancer group, N = 31) and traditional ischemic stroke (control group, N = 662). The sociodemographic data, risk factors for stroke, National Institutes of Health Stroke Scale (NIHSS) scores on admission, platelet count, D-dimer, fibrinogen and C-reactive protein (CRP) level, features of infarcts on diffusion-weighted imaging [DWI, which was acute multiple ischemic lesions located in more than one vascular territories (AMIMCT)], and the tumor type and histological classification in cancer group were recorded. Univariate and multivariate backward Logistic regression analysis were used to analyze the influencing factors of cancer-associated ischemic stroke. Results Compared with control group, patients in cancer group had older age (χ² = 2.148, P = 0.032), lower proportion of hypertension (χ² = 5.425, P = 0.020) and hyperlipidemia (Fisher exact probability: P = 0.000), and elevated levels of serum D-dimer (Z = 2687.500, P = 0.001), fibrinogen (t = 2.402, P = 0.022) and CRP (Z = 3669.000, P = 0.001). There was significant difference between 2 groups on TOAST (Fisher exact probability: P = 0.000). Patients in cancer group had lower proportion of large artery atherosclerosis (LAA; Fisher exact probability: P = 0.000), but higher proportion of stroke of undetermined etiology (SUE; χ² = 175.418, P = 0.000) and AMIMCT (χ² = 22.560, P = 0.000). Multivariate backward Logistic regression analysis showed having no history of hyperlipidemia (OR = 0.188, 95%CI: 0.048-0.730; P = 0.016), SUE (OR = 29.854, 95%CI: 10.310-86.449; P = 0.000), elevated levels of D?dimer (OR = 1.663, 95%CI: 1.294-2.137; P = 0.000) and fibrinogen (OR = 1.785, 95% CI: 1.294-2.137; P = 0.000) were risk factors for cancer-associated ischemic stroke. Conclusions It is usually lack of evidence of LAA for cancer-associated ischemic stroke. Elevated D-dimer and fibrinogen, and SUE demonstrated that hypercoagulability and microembolus embolism may be the possible mechanism of cancer-associated ischemic stroke.

DOI: 10.3969/j.issn.1672-6731.2019.05.010