Absence of Susceptibility Vessel Sign in Patients With Malignancy-Related Acute Ischemic Stroke Treated With Mechanical Thrombectomy

Morin Beyeler; Nebiyat F Belachew; Moritz Kielkopf; Enrique B Aleman; Alejandro Xavier León Betancourt; Kotryna Genceviciute; Christoph Kurmann; Lorenz Grunder; Barbara Birner; Thomas R Meinel; Adrian Scutelnic; Philipp Bücke; David J Seiffge; Tomas Dobrocky; Eike I Piechowiak; Sara Pilgram-Pastor; Heinrich P Mattle; Pasquale Mordasini; Marcel Arnold; Urs Fischer; Thomas Pabst; Jan Gralla; Martin D Berger; Simon Jung; Johannes Kaesmacher

doi:10.3389/fneur.2022.930635

Absence of Susceptibility Vessel Sign in Patients With Malignancy-Related Acute Ischemic Stroke Treated With Mechanical Thrombectomy

Front Neurol. 2022 Jul 14:13:930635. doi: 10.3389/fneur.2022.930635. eCollection 2022.

Authors

Morin Beyeler^{1

2}, Nebiyat F Belachew^{3

4}, Moritz Kielkopf¹, Enrique B Aleman⁴, Alejandro Xavier León Betancourt¹, Kotryna Genceviciute¹, Christoph Kurmann³, Lorenz Grunder³, Barbara Birner¹, Thomas R Meinel¹, Adrian Scutelnic¹, Philipp Bücke¹, David J Seiffge¹, Tomas Dobrocky³, Eike I Piechowiak³, Sara Pilgram-Pastor³, Heinrich P Mattle¹, Pasquale Mordasini³, Marcel Arnold¹, Urs Fischer^{1

5}, Thomas Pabst⁶, Jan Gralla³, Martin D Berger⁶, Simon Jung¹, Johannes Kaesmacher³

Affiliations

¹ Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
³ Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Department of Neuroradiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.
⁵ Department of Neurology, University Hospital of Basel, University of Basel, Basel, Switzerland.
⁶ Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Abstract

Background and purpose: Clots rich in platelets and fibrin retrieved from patients with acute ischemic stroke (AIS) have been shown to be independently associated with the absence of the susceptibility vessel sign (SVS) on MRI and active malignancy. This study analyzed the association of SVS and the presence of active malignancy in patients with AIS who underwent mechanical thrombectomy (MT).

Methods: This single-center, retrospective, and cross-sectional study included consecutive patients with AIS with admission MRI treated with MT between January 2010 and December 2018. SVS status was evaluated on susceptibility-weighted imaging. Adjusted odds ratios (aORs) were calculated to determine the association between absent SVS and the presence of active or occult malignancy. The performance of predictive models incorporating and excluding SVS status was compared using areas under the receiver operating characteristics curve (auROC).

Results: Of 577 patients with AIS with assessable SVS status, 40 (6.9%) had a documented active malignancy and 72 (12.5%) showed no SVS. The absence of SVS was associated with active malignancy (aOR 4.85, 95% CI 1.94-12.11) or occult malignancy (aOR 11.42, 95% CI 2.36-55.20). The auROC of predictive models, including demographics and common malignancy biomarkers, was higher but not significant (0.85 vs. 0.81, p = 0.07) when SVS status was included.

Conclusion: Absence of SVS on admission MRI of patients with AIS undergoing MT is associated with malignancy, regardless of whether known or occult. Therefore, the SVS might be helpful in detecting paraneoplastic coagulation disorders and occult malignancy in patients with AIS.

Keywords: biomarkers; ischemic stroke; malignancy-related stroke; mechanical thrombectomy; paraneoplastic coagulation disorders; susceptibility vessel sign; thrombus composition/occult malignancy.

Copyright © 2022 Beyeler, Belachew, Kielkopf, Aleman, León Betancourt, Genceviciute, Kurmann, Grunder, Birner, Meinel, Scutelnic, Bücke, Seiffge, Dobrocky, Piechowiak, Pilgram-Pastor, Mattle, Mordasini, Arnold, Fischer, Pabst, Gralla, Berger, Jung and Kaesmacher.