Temporal Trends in the Use of Acute Recanalization Therapies for Ischemic Stroke in Patients with Cancer

Abstract

Objective: We sought to characterize the US nationwide temporal trends in recanalization therapy utilization for ischemic stroke among patients with and without cancer.

Methods: We identified all acute ischemic stroke (AIS) hospitalizations in the National Inpatient Sample from January 1, 1998 to September 30, 2015. The primary exposure was solid or hematologic cancer. The primary outcome was use of intravenous thrombolysis. The secondary outcome was use of endovascular therapy (EVT).

Results: Among 9,508,804 AIS hospitalizations, 503,510 (5.3%) involved cancer patients. Intravenous thrombolysis use among ischemic stroke patients with cancer increased from .01% (95% confidence interval [CI], .00%-.02%) in 1998 to 4.91% (95% CI, 4.33%-5.48%) in 2015, whereas intravenous thrombolysis use among ischemic stroke patients without cancer increased from .02% (95% CI, .01%-.02%) in 1998 to 7.22% (95% CI, 6.98%-7.45%) in 2015. The demographic- and comorbidity-adjusted odds ratio/year of receiving intravenous thrombolysis was similar in patients with cancer (1.21; 95% CI, 1.20-1.23) versus those without (1.20; 95% CI, 1.19-1.21). EVT use among ischemic stroke patients with cancer increased from .05% (95% CI, .02%-.07%) in 2006 to 1.90% (95% CI, 1.49%-2.31%) in 2015, whereas EVT use among ischemic stroke patients without cancer increased from .09% (95% CI, .00%-.18%) in 2006 to 1.88% (95% CI, 1.68%-2.09%) in 2015.

Conclusions: Among 9.5 million AIS hospitalizations, patients with cancer received intravenous thrombolysis about two thirds as often as patients without cancer. This difference persisted over time despite increased utilization in both groups. EVT utilization was similar between cancer and non-cancer AIS patients.

Keywords: Cancer; endovascular therapy; ischemic stroke; oncology; recanalization therapy; thrombolysis.

Figure 1.

A and B. Intravenous Thrombolysis Use Among Hospitalizations for Ischemic Stroke in the National Inpatient Sample, 1998–2015. A. Annual rates of intravenous thrombolysis use among hospitalizations for acute ischemic stroke in the National Inpatient Sample from 1998–2015. Data is stratified by the presence of comorbid cancer. The lighter shade sections of the curves denote 95% confidence intervals. B. Annual rates of intravenous thrombolysis use among hospitalizations for acute ischemic stroke in patients with cancer in the National Inpatient Sample from 1998–2015. Data is stratified by cancer type, including patients with non-metastatic hematologic cancers, non-metastatic solid cancers, and metastatic hematologic or solid cancers.

Figure 1.

A and B. Intravenous Thrombolysis Use Among Hospitalizations for Ischemic Stroke in the National Inpatient Sample, 1998–2015. A. Annual rates of intravenous thrombolysis use among hospitalizations for acute ischemic stroke in the National Inpatient Sample from 1998–2015. Data is stratified by the presence of comorbid cancer. The lighter shade sections of the curves denote 95% confidence intervals. B. Annual rates of intravenous thrombolysis use among hospitalizations for acute ischemic stroke in patients with cancer in the National Inpatient Sample from 1998–2015. Data is stratified by cancer type, including patients with non-metastatic hematologic cancers, non-metastatic solid cancers, and metastatic hematologic or solid cancers.

Figure 2.

A and B Endovascular Therapy Use Among Hospitalizations for Ischemic Stroke in the National Inpatient Sample, 2006–2015. A. Annual rates of endovascular therapy use among hospitalizations for acute ischemic stroke in the National Inpatient Sample from 2006–2015. Data is stratified by the presence of comorbid cancer. The lighter shade sections of the curves denote 95% confidence intervals. B. Annual rates of endovascular therapy use among hospitalizations for acute ischemic stroke in patients with cancer in the National Inpatient Sample from 2006–2015. Data is stratified by cancer type, including patients with non-metastatic hematologic cancers, non-metastatic solid cancers, and metastatic hematologic or solid cancers.

Figure 2.

A and B Endovascular Therapy Use Among Hospitalizations for Ischemic Stroke in the National Inpatient Sample, 2006–2015. A. Annual rates of endovascular therapy use among hospitalizations for acute ischemic stroke in the National Inpatient Sample from 2006–2015. Data is stratified by the presence of comorbid cancer. The lighter shade sections of the curves denote 95% confidence intervals. B. Annual rates of endovascular therapy use among hospitalizations for acute ischemic stroke in patients with cancer in the National Inpatient Sample from 2006–2015. Data is stratified by cancer type, including patients with non-metastatic hematologic cancers, non-metastatic solid cancers, and metastatic hematologic or solid cancers.