Journal: Stroke
This scientific statement reviews ischemic stroke occurring in patients with active cancer and proposes a unified framework for its classification and management.
Key points:
- Epidemiology and burden
- About 10–15% of ischemic stroke patients have a history of cancer.
- Roughly half of these have active malignancy at the time of stroke.
- As cancer survival improves, the overlap between cancer and stroke has been steadily increasing since 2000.
- Stroke mechanisms in cancer
- Around half of ischemic strokes in patients with active cancer are explained by conventional mechanisms (e.g., atherosclerotic disease, atrial fibrillation), though cancer may still contribute.
- The other half are usually cryptogenic or attributed to cancer-specific mechanisms.
- These cryptogenic strokes in cancer patients often:
- Have characteristic risk markers and clinical features.
- Carry an extremely high risk of recurrent stroke and other adverse events.
- Appear distinct from other etiologic stroke subtypes.
- Pathophysiology
- Epidemiologic, translational, and histopathologic data collectively support that many of these cryptogenic events are directly driven by the malignancy.
- The primary mechanism is a multifactorial prothrombotic state induced by cancer, leading to arterial thromboembolism.
- Proposed terminology and classification
- The authors introduce the term “cancer-related stroke” for ischemic strokes attributed to the cancer itself.
- They propose a classification system:
- Based on routinely obtainable clinical data.
- Includes levels of certainty regarding causal attribution to cancer.
- Tied to distinctive clinical features and estimated risk of recurrent thromboembolism.
- The goal is to standardize nomenclature and harmonize stroke classification in cancer across research and clinical practice.
- Clinical implications
- The statement offers guidance on:
- Recognizing clinical presentations typical for cancer-related stroke.
- Approach to evaluation and workup in patients with active cancer and ischemic stroke.
- Conceptual frameworks for treatment, particularly in the context of high recurrence risk.
- The authors emphasize the urgent need for dedicated controlled trials to address unresolved questions in prevention and management of stroke in patients with active cancer.