Trends in Thrombolysis and Thrombectomy Use in Patients With Ischemic Stroke and Cancer

Background: To determine how intravenous thrombolysis (IV-tPA) and mechanical thrombectomy (MT) use has changed in patients with acute ischemic stroke (AIS) with cancer (AIS-C) compared with patients with AIS and noncancer (AIS-NC) in the United States since publication of pivotal MT trials. Methods: All primary AIS-NC and AIS-C admissions (weighted N=5 748 357) were identified from the 2007 to 2019 Nationwide Inpatient Sample. Joinpoint and multivariable-adjusted models with interaction terms were used to compare the rate of change in IV-tPA and MT use between AIS-C and AIS-NC. Results: From 2007 to 2019, 4.4% of AIS admissions had active cancer. Overall IV-tPA use in AIS-C (6.4%) was lower than that of AIS-NC (8.5%) (P<0.001) but use differed by cancer subtype (hematologic, 7.2%; metastatic, 4.2%). IV-tPA use increased over time in all cancers, but analysis of status-by-time interaction revealed that the pace of increase was slower in metastatic compared with AIS-NC admissions (rate ratio, 0.98; P=0.015) per year. In contrast, MT use in AIS-C (2.2%) was greater than that of AIS-NC (1.9%), but use was highest in metastatic (2.5%) and lowest in hematologic cancers (1.6%) (P values for all pairwise comparisons <0.001). MT use increased at a faster pace in metastatic AIS-C (rate ratio, 1.06; P=0.001)/year compared with AIS-NC. In-hospital all-cause mortality in AIS-NC was 4.2% compared with 8.2% in AIS-C (P<0.001). Mortality declined over time in all cancer groups, but the pace of decline was faster in solid and metastatic AIS-C compared with AIS-NC (P values <0.01). Conclusions: Use of IV-tPA and MT has increased in AIS-C over the past decade. Contrary to prior studies, the current frequency and pace of increase in MT use is greater in metastatic AIS-C compared with AIS-NC. Future studies are needed to determine whether AIS-C are more predisposed to large-vessel occlusion.