TOPLINE:

Recanalisation therapies were associated with higher odds of in‑hospital mortality and bleeding in patients with cancer who suffered an acute ischaemic stroke vs those without cancer, with variation by cancer subtype. Acute anaemia emerged as the most common complication, particularly in gastrointestinal cancers.

METHODOLOGY:

• Researchers in Germany conducted a retrospective cohort study to assess the safety of recanalisation therapies (intravenous thrombolysis and endovascular thrombectomy) in patients with cancer who suffered an acute ischaemic stroke.
• Using nationwide administrative data from the German Federal Statistical Office, they analysed 154,333 patients who received intravenous thrombolysis (2482 with cancer; 41.78% women and 151,851 without cancer; 47.31% women) and 39,534 patients who were treated with endovascular thrombectomy (1580 with cancer; 49.56% women and 37,954 without cancer; 54.04% women).
• In-hospital mortality and safety outcomes, including intracranial bleeding, subarachnoid haemorrhage, and acute anaemia, were evaluated.
• Cancer status was identified using standardised codes, and patients were stratified by cancer localisation to assess heterogeneity in complication profiles across cancer subtypes.

TAKEAWAY:

• In the thrombolysis cohort, patients with cancer had 83% higher odds of in-hospital mortality (odds ratio [OR], 1.83; P < .001) and 27% higher odds of intracranial bleeding (OR, 1.27; P = .005) than those without cancer.
• In the thrombectomy cohort, patients with cancer had 56% higher odds of in-hospital mortality and 33% higher odds of subarachnoid haemorrhage (P < .05 for both).
• After multivariable adjustment, patients with respiratory cancer had 2.86- and 3.09-fold higher odds of mortality after thrombolysis and thrombectomy, respectively, and those with gastrointestinal cancer had 2.35-fold increased odds of mortality after thrombolysis (P < .001 for all).
• Acute anaemia was the most common complication across multiple cancer subtypes, with more than 10-fold higher odds among patients with gastrointestinal cancer who underwent both thrombolysis and thrombectomy (P < .001 for both).

IN PRACTICE:

"[The study] findings advocate for a tailored, risk-based approach to recanalization therapies, weighing individual complication profiles. This approach aims to optimize patient safety and management, potentially improving outcomes in this vulnerable population, rather than adhering to a general exclusion of cancer patients from acute stroke therapy," the authors wrote.

SOURCE:

This study was led by Robin Jansen, Heinrich-Heine-University, Düsseldorf, Germany. It was published online on May 29, 2026, in the Journal of Neurology.

LIMITATIONS:

The retrospective study design restricted definitive causal associations. Deaths related to cancer and deaths due to acute therapy could not be differentiated. The case-based design allowed patients readmitted for a recurrent stroke within the same year to be counted multiple times, potentially introducing bias due to higher recurrence rates in patients with cancer.

DISCLOSURES:

This study was sponsored through domestic funds. Several authors declared receiving travel grants, honoraria for lectures, or consultancy fees from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.