Concurrent Use of Contact Aspiration and a Stent Retriever Is Associated With Successful Recanalization in Patients With Cancer-Associated Stroke.

BACKGROUND AND PURPOSE: The optimal thrombectomy technique in emergent large vessel occlusion due to cancer-associated coagulopathy remains uncertain. We aimed to investigate the efficacy and safety of concurrent contact aspiration and stent retriever in this stroke subtype. METHODS: We retrospectively analyzed consecutive ischemic stroke patients who had undergone endovascular thrombectomy. Patients were characterized as having cancer-associated stroke (CAS) or non-cancer-associated stroke (non-CAS). Thrombectomy technique was classified as a single strategy (either contact aspiration or a stent retriever) or a combined technique (concurrent use of contact aspiration and a stent retriever at least once). Successful recanalization was defined as a modified TICI grade 2b or 3 at the end of the procedure. Factors associated with successful recanalization were analyzed. RESULTS: The present study enrolled 393 patients. Of these patients, 56 (14.2%) were found to have cancer-associated stroke. Rates of recanalization (69.6% vs. 91.7%, p<0.001) and 3-month good clinical outcomes (25.5% vs. 42.0%, p=0.025) were significantly lower in patients with CAS than non-CAS, respectively. Although the combined technique was not associated with successful recanalization in the entire cohort, the combined technique was associated with successful recanalization in patients with CAS (odds ratio 6.256, 95% confidence interval, 1.224-31.970; p=0.028). The interaction term between the combined technique and the stroke subtype (CAS vs. non-CAS) was independently associated with successful recanalization (p=0.029). CONCLUSIONS: The combined technique was associated with successful recanalization in patients with cancer-associated stroke and emergent large vessel occlusion.