Assessing the Effects of Intracranial Atherosclerosis and AFib on the Prognosis of Ischemic Stroke with Active Cancer

A study found that intracranial atherosclerosis (ICAS), but not atrial fibrillation (AF), was closely associated with poor prognosis in ischemic stroke patients with active cancer. The results were published in PLoS One.

In ischemic stroke patients with active cancer, cryptogenic stroke has worse prognosis than stroke by conventional mechanisms. However, the individual effects of ICAS or AF on the prognosis of these patients have not been studied,” the researchers wrote.

This study consisted of a total of 116 ischemic stroke patients with active cancer diagnosed between 2010 and 2020. Early neurological deterioration (END) was defined as an increase of ≥ 1 in the motor NIHSS score, or ≥ 2 in the total NIHSS score within 72 hours of admission. The study defined unfavorable outcomes as a score of ≥ 3 on the 3-month modified Rankin Scale.

The results showed that ICAS was positively associated with END (adjusted odds ratio [aOR] = 4.56, 95% confidence interval [CI, 1.52-13.70), and this association showed a quantitative relationship according to the degree of stenosis of ICAS (stenosis group: aOR = 4.24, 95% CI: 1.31-13.72; occlusion group, aOR = 5.74, 95% CI: 1.05-31.30). ICAS was also closely related to unfavorable outcomes (aOR = 6.33, 95% CI: 1.15-34.79). In contrast, AF showed no significant association with END or unfavorable outcomes. Our data showed that patients with ICAS had larger and more severe initial stroke lesions, and poorer prognosis than those without.

The researchers reported several limitations. Firstly, since this study followed a retrospective cross-sectional design, it only delved into associations and not the causality. Secondly, some patients with occlusive ICAS have the potential for acute occlusion, the researchers noted. Thirdly, if follow-up MRI results were available, it would have helped to explain the mechanism of how ICAS actually causes END. Fourth, the impact of non-neurological complications including stroke-associated pneumonia should be considered []. Last, though we used a relatively sensitive definition of END [], since ICAS showed a statistically significant association with unfavorable outcomes based on the 3-month mRS scores, we can interpret that it exerts sufficient influence on the prognosis.

“We demonstrated that ICAS was closely associated with poor prognosis during the acute to subacute period in ischemic stroke patients with active cancer. This association appeared to be related to the tendency to form large and severe initial stroke lesions when accompanied by ICAS,” the researchers concluded.

“Therefore, by performing the initial MRA together, we can help classify high-risk groups with poor prognosis later. However, further prospective studies are needed to validate our results.”