Recurrent Thromboembolic Events after Ischemic Stroke in Patients with Primary Brain Tumors.

TitleRecurrent Thromboembolic Events after Ischemic Stroke in Patients with Primary Brain Tumors.
Publication TypeJournal Article
Year of Publication2017
AuthorsParikh NS, Burch JE, Kamel H, DeAngelis LM, Navi BB
JournalJ Stroke Cerebrovasc Dis
Date Published2017 Oct
KeywordsAged, Brain Ischemia, Brain Neoplasms, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Magnetic Resonance Imaging, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Recurrence, Retrospective Studies, Stroke, Thromboembolism

BACKGROUND: Stroke mechanisms and the risk of recurrent thromboembolism are incompletely understood in patients with primary brain tumors. We sought to better delineate these important clinical features.

METHODS: We performed a retrospective cohort study of adults with primary brain tumors diagnosed with magnetic resonance imaging-confirmed acute ischemic stroke at the Memorial Sloan Kettering Cancer Center from 2005 to 2015. Study neurologists collected data on patients' cancer history, stroke risk factors, treatments, and outcomes. Stroke mechanisms were adjudicated by consensus. The primary outcome was recurrent thromboembolism (arterial or venous) and the secondary outcome was recurrent ischemic stroke. Kaplan-Meier statistics were used to calculate cumulative outcome rates, and Cox hazards analysis was used to evaluate the association between potential risk factors and outcomes.

RESULTS: We identified 83 patients with primary brain tumors and symptomatic acute ischemic stroke. Median survival after index stroke was 2.2 years (interquartile range, .5-7.0). Tumors were mostly gliomas (72%) and meningiomas (13%). Most strokes were from unconventional mechanisms, particularly radiation vasculopathy (36%) and surgical manipulation (18%). Small- or large-vessel disease or cardioembolism caused 13% of strokes, whereas 29% were cryptogenic. Cumulative recurrent thromboembolism rates were 11% at 30 days, 17% at 180 days, and 27% at 365 days, whereas cumulative recurrent stroke rates were 5% at 30 days, 11% at 180 days, and 13% at 365 days. We found no significant predictors of outcomes.

CONCLUSION: Patients with primary brain tumors generally develop strokes from rare mechanisms, and their risk of recurrent thromboembolism, including stroke, is high.

Alternate JournalJ Stroke Cerebrovasc Dis
PubMed ID28647417
PubMed Central IDPMC5600665
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States

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