Authors: Vishnu Byroju, Jamir Pitton Rissardo, and Ana Leticia Fornari Caprara
Conference: 2025 AAN Annual Meeting, San Diego, CA
Objective
To review the literature on tumor embolic stroke (TES) undergoing endovascular thrombectomy (EVT).
Background
Although it is well recognized, the literature regarding EVT in TES is scarce. Some studies have found a high risk of intracranial hemorrhage (ICH) after thrombolysis in patients with cancer-related stroke (CRS).
Design/Methods
The PubMed (Medline) database was used to find the studies in electronic form about EVT in TES published to June 2024. The search terms to use for the search were “tumor, stroke, and thrombectomy.” There was no language restriction. The initial search obtained 177 studies, from which 50 were selected. Only fragment or entire tumor dislodgement resulting in a stroke, which is a subset of CRS, was included.
Results
The median age was 45.8, female subjects comprised 15 out of 50, gender was not reported in 2 and the rest were male. 7/50 were pediatric cases with age <21. 1 case reported adverse outcomes, the rest did not have complications from EVT. Deaths reported later in the hospital course were primarily attributable to complications from underlying malignancy or respiratory failure. 24/50 TES were secondary to myxoma. Several other tumors, including but not limited to cardiac papillary fibroelastomas, amorphous tumors, sarcomas, and renal cell carcinomas, resulted in TES. The rate of ICH in TES is comparable to that of patients without active malignancy (5–10% in both groups).
Conclusions
A literature review suggests EVT is safe in TES, and novel techniques improve outcomes. The rate of ICH in patients undergoing EVT for stroke is similar in patients with and without cancer. EVT demonstrates safety in TES. Several novel techniques of EVT demonstrate safety and efficacy in treating TES; in certain cases, outcomes are superior to medical management alone.
Citation
Byroju V, Rissardo JP, Caprara AL. Tumor Embolic Stroke and Endovascular Thrombectomy: A Literature Review (P8-13.012). Neurology 2025;104(7_Supplement_1):3124). doi: 10.1212/WNL.0000000000210810
Figure. Incidence, localization, and outcomes of tumor embolic stroke (TES). The top panel presents the distribution of tumor types implicated in TES, with cardiac myxoma comprising the largest proportion (47%), followed by sarcomatoid carcinoma (26%), papillary fibroelastoma (16%), and smaller contributions from lung malignancy (5%), metastatic melanoma (2%), phyllodes breast tumor (2%), and cardiac sarcoma (2%). The lower left panel summarizes outcomes following endovascular therapy (EVT), showing favorable results in 47% of cases, poor outcomes in 13%, favorable outcomes with unrelated mortality in another 13%, and unknown outcomes in 27%. The lower right panel maps the vascular territories affected by TES, highlighting occlusions in the right middle cerebral artery (32%), left internal carotid artery (26%), basilar/posterior circulation (26%), and right internal carotid artery (16%).