Mechanical thrombectomy for acute large vessel occlusion in patients with active malignancy: Functional outcomes, one-year survival, and continuation of anticancer therapy.

OBJECTIVE: Mechanical thrombectomy (MT) is an established treatment for acute ischemic stroke caused by large vessel occlusion (LVO). However, the benefit of MT in patients with active cancer remains uncertain because of concerns regarding hypercoagulability, poor systemic conditions and limited life expectancy. We investigated the efficacy and clinical relevance of MT in patients with active cancer, with particular attention to the functional outcomes, long-term survival, and feasibility of continuing anticancer therapy after stroke. METHODS: We retrospectively reviewed consecutive patients who underwent MT for acute LVO at our institution between January 2019 and December 2024. Patients were classified into an active cancer group and a control group without active cancer. Active cancer was defined as either receipt of cancer treatment (surgery, chemotherapy, immunotherapy, hormonal therapy, or radiotherapy) within 6 months before stroke onset or a new diagnosis of malignancy at the stroke onset. The primary outcomes were favorable functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score of 0-2, and survival for at least 1 year. Secondary outcomes included 90-day mortality, and continuation of anticancer therapy. RESULTS: A total of 151 patients were included, comprising 31 patients with active cancer and 120 controls. Favorable functional outcomes at 90 days were observed in 38.7% and 33.3% of the active cancer group and control groups, respectively, with no significant difference (P = 0.67). 90-day mortality was significantly higher in the active cancer group (41.9% vs. 12.5%, P = 0.001). Kaplan-Meier analysis demonstrated significantly poorer 1-year overall survival in patients with active malignancy (log-rank P = 0.001). Nevertheless, ten patients (32.3%) with active cancer survived at least one year, and eight (25.8%) continued or resumed anticancer therapy after stroke. CONCLUSIONS: In selected patients with active cancer, the observed rate of favorable functional outcome after MT was not significantly different from that in patients without malignancy, although formal equivalence was not established. Importantly, approximately one-third of patients survived beyond one year, and one-quarter were able to continue anticancer therapy. These findings support individualized decision-making regarding MT based on both neurological and oncological prognosis.