Cancer-Associated Arterial Thrombosis: An Updated Investigation of Cancer-Associated Ischemic Stroke

Abstract

The recognition of cancer-associated ischemic stroke is increasing, shedding light on the previously overlooked problem of cancer-associated ESUS and its impact on late-stage cancer diagnoses. There is growing acknowledgment of the hypercoagulable state in cancer patients with ischemic stroke, with the risk of stroke significantly rising in the year preceding a cancer diagnosis, reaching its peak just before diagnosis. Several cancer types, with lung cancer being the most prevalent, are linked to cancer-associated ischemic stroke. The complex pathophysiology of this condition involves malignancy-related intravascular hypercoagulability, characterized by non-bacterial thrombotic endocarditis (NBTE) and paradoxical embolization as key mechanisms. The diagnostic work-up for stroke patients with cancer should include a standard etiological assessment, supplemented by an occult cancer detection protocol that encompasses various blood tests (especially D-dimer), imaging techniques, and Thoraco-Abdominal-Pelvic Computed Tomography (CT). Ongoing research explores the potential addition of FDG PET/CT to conventional cancer screening. Furthermore, a recent study investigating cancer-associated strokes introduced a machine learning-based prediction model utilizing immunohistochemically stained thrombi obtained during thrombectomy.