{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T17:55:11Z","timestamp":1781373311808,"version":"3.54.1"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum D\u00fcsseldorf. Anstalt \u00f6ffentlichen Rechts"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Stroke is a common risk among patients with cancer, and the odds of a fatal stroke are estimated to be twice those of the general population. Due to the exclusion of cancer patients from major intravenous thrombolysis and thrombectomy trials, existing literature consists largely of small case series lacking sufficient statistical power. We aimed to evaluate the safety profile of acute stroke therapies in patients with active cancer, stratified by cancer localization, using a nationwide administrative dataset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective, large-scale cohort study utilized data from the German Federal Statistical Office (DESTATIS). We analyzed all inpatient cases of acute ischemic stroke receiving recanalization therapy (intravenous thrombolysis and endovascular thrombectomy) in Germany. The primary endpoints were in-hospital mortality and safety outcomes (intracranial bleeding, subarachnoid hemorrhage, and acute anemia). To control for baseline characteristics, adjusted odds ratios (aOR) were calculated using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We analyzed 154,333 patients receiving intravenous thrombolysis (2482 with and 151,851 without cancer) and 39,534 receiving endovascular thrombectomy (1580 with and 37,954 without cancer). In the thrombolysis cohort, patients with cancer had significantly higher rates of in-hospital death (10.88% vs. 6.26%; OR 1.83;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and intracranial bleeding (5.76% vs. 4.58%; OR 1.27;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). Similarly, in the thrombectomy cohort, active cancer was associated with increased in-hospital mortality (28.10% vs. 20.00%; OR 1.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and subarachnoid hemorrhage (6.14% vs. 4.67%; OR 1.33;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007). After multivariable adjustment, stratification revealed highly heterogeneous complication profiles depending heavily on the specific cancer subtype.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This large-scale analysis demonstrates that while mortality and specific bleeding risks are generally elevated in stroke patients with malignancies, these risks depend strongly on the cancer subtype. These findings advocate for a tailored, risk-based approach to recanalization therapy, weighing individual complication profiles rather than a general exclusion of patients with cancer from acute stroke therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-13851-9","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T04:54:59Z","timestamp":1780030499000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recanalization therapy in stroke patients with malignancies: in-hospital outcomes by cancer subtype in a nationwide administrative data analysis"],"prefix":"10.1007","volume":"273","author":[{"given":"Robin","family":"Jansen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Gammersbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan","family":"K\u00f6lsche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven G.","family":"Meuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Schmidt-Pogoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Schreiber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Ruck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John-Ih","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gliem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"13851_CR1","unstructured":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132021: a systematic analysis for the Global Burden of Disease Study 2021 - The Lancet Neurology. https:\/\/www.thelancet.com\/journals\/laneur\/article\/PIIS1474-4422(24)00369-7\/fulltext"},{"key":"13851_CR2","doi-asserted-by":"publisher","unstructured":"2025 Heart disease and stroke statistics: a report of US and global data from the American Heart Association, Circulation; https:\/\/doi.org\/10.1161\/CIR.0000000000001303","DOI":"10.1161\/CIR.0000000000001303"},{"key":"13851_CR3","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1016\/S0140-6736(25)01635-6","volume":"406","author":"LM Force","year":"2025","unstructured":"Force LM et al (2025) The global, regional, and national burden of cancer, 1990\u20132023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023. Lancet 406:1565\u20131586","journal-title":"Lancet"},{"key":"13851_CR4","first-page":"5172","volume":"10","author":"NG Zaorsky","year":"2019","unstructured":"Zaorsky NG et al (2019) Stroke among cancer patients Nat Commun 10:5172","journal-title":"Stroke among cancer patients Nat Commun"},{"key":"13851_CR5","doi-asserted-by":"publisher","unstructured":"Admission rates, time trends, risk factors, and outcomes of ischemic and hemorrhagic stroke from German Nationwide Data, Neurology.https:\/\/doi.org\/10.1212\/WNL.0000000000201259","DOI":"10.1212\/WNL.0000000000201259"},{"key":"13851_CR6","volume":"2","author":"JL Dearborn","year":"2014","unstructured":"Dearborn JL, Urrutia VC, Zeiler SR (2014) Stroke and cancer- a complicated relationship. J Neurol Transl Neurosci 2:1039","journal-title":"J Neurol Transl Neurosci"},{"key":"13851_CR7","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","volume":"50","author":"WJ Powers","year":"2019","unstructured":"Powers WJ et al (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke 50:e344\u2013e418","journal-title":"Stroke"},{"key":"13851_CR8","doi-asserted-by":"publisher","unstructured":"Clinical outcome after endovascular treatment in patients with active cancer and ischemic stroke, Neurology https:\/\/doi.org\/10.1212\/WNL.0000000000013316","DOI":"10.1212\/WNL.0000000000013316"},{"key":"13851_CR9","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1007\/s00415-025-13458-6","volume":"272","author":"V Cancelloni","year":"2025","unstructured":"Cancelloni V et al (2025) Intravenous thrombolysis in patients with acute ischaemic stroke and active cancer (the ITACA-stroke study). J Neurol 272:723","journal-title":"J Neurol"},{"key":"13851_CR10","doi-asserted-by":"publisher","first-page":"164","DOI":"10.5853\/jos.2023.03279","volume":"26","author":"JH Heo","year":"2024","unstructured":"Heo JH et al (2024) Cancer-associated stroke: thrombosis mechanism, diagnosis, outcome, and therapeutic strategies. J Stroke 26:164\u2013178","journal-title":"J Stroke"},{"key":"13851_CR11","unstructured":"Bang, O. Y. (2018) Edoxaban for the treatment of coagulopathy in patients with active cancer and acute ischemic stroke: a pilot study. (ENCHASE Study) https:\/\/clinicaltrials.gov\/study\/NCT03570281"},{"key":"13851_CR12","doi-asserted-by":"publisher","DOI":"10.1177\/11795549241308090","volume":"18","author":"\u0130 Ac\u0131r","year":"2024","unstructured":"Ac\u0131r \u0130, Erdo\u011fan HA, Toka E, Yayla V (2024) The influence of cancer type on stroke incidence: a retrospective study. Clin Med Insights Oncol 18:11795549241308090","journal-title":"Clin Med Insights Oncol"},{"key":"13851_CR13","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1172\/JCI200318882","volume":"112","author":"M Wahrenbrock","year":"2003","unstructured":"Wahrenbrock M, Borsig L, Le D, Varki N, Varki A (2003) Selectin-mucin interactions as a probable molecular explanation for the association of Trousseau syndrome with mucinous adenocarcinomas. J Clin Invest 112:853\u2013862","journal-title":"J Clin Invest"},{"key":"13851_CR14","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1007\/s00062-014-0347-x","volume":"26","author":"T Boeckh-Behrens","year":"2016","unstructured":"Boeckh-Behrens T et al (2016) The impact of histological clot composition in embolic stroke. Clin Neuroradiol 26:189\u2013197","journal-title":"Clin Neuroradiol"},{"key":"13851_CR15","doi-asserted-by":"publisher","first-page":"84","DOI":"10.2174\/187152910791292484","volume":"10","author":"EE Mazokopakis","year":"2010","unstructured":"Mazokopakis EE, Syros PK, Starakis IK (2010) Nonbacterial thrombotic endocarditis (marantic endocarditis) in cancer patients. Cardiovasc Hematol Disord Drug Targets 10:84\u201386","journal-title":"Cardiovasc Hematol Disord Drug Targets"},{"key":"13851_CR16","doi-asserted-by":"publisher","first-page":"1933","DOI":"10.1001\/jama.2019.3076","volume":"321","author":"RGS Meester","year":"2019","unstructured":"Meester RGS, Mannalithara A, Lansdorp-Vogelaar I, Ladabaum U (2019) Trends in incidence and stage at diagnosis of colorectal cancer in adults aged 40 through 49 years, 1975-2015. JAMA 321:1933\u20131934","journal-title":"JAMA"},{"key":"13851_CR17","first-page":"212","volume":"57","author":"RD Neal","year":"2007","unstructured":"Neal RD et al (2007) Stage, survival and delays in lung, colorectal, prostate and ovarian cancer: comparison between diagnostic routes. Br J Gen Pract 57:212\u2013219","journal-title":"Br J Gen Pract"},{"key":"13851_CR18","doi-asserted-by":"publisher","first-page":"e2583","DOI":"10.1212\/WNL.0000000000201208","volume":"99","author":"SD Shapiro","year":"2022","unstructured":"Shapiro SD et al (2022) Investigating outcomes post\u2013endovascular thrombectomy in acute stroke patients with cancer. Neurology 99:e2583\u2013e2592","journal-title":"Neurology"},{"key":"13851_CR19","doi-asserted-by":"publisher","first-page":"3573","DOI":"10.1161\/STROKEAHA.113.003058","volume":"44","author":"SB Murthy","year":"2013","unstructured":"Murthy SB et al (2013) Thrombolysis for acute ischemic stroke in patients with cancer. Stroke 44:3573\u20133576","journal-title":"Stroke"},{"key":"13851_CR20","first-page":"347","volume":"61","author":"C de la Fouchardi\u00e8re","year":"2003","unstructured":"de la Fouchardi\u00e8re C, Flechon A, Droz JP (2003) Coagulopathy in prostate cancer. Neth J Med 61:347\u2013354","journal-title":"Neth J Med"},{"key":"13851_CR21","doi-asserted-by":"crossref","unstructured":"Inui, R. et al. (2023) Detrimental effect of anemia after mechanical thrombectomy on functional outcome in patients with ischemic stroke. Front Neurol; 14","DOI":"10.3389\/fneur.2023.1299891"},{"key":"13851_CR22","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1177\/2396987319889468","volume":"5","author":"VL Altersberger","year":"2020","unstructured":"Altersberger VL et al (2020) Effect of haemoglobin levels on outcome in intravenous thrombolysis-treated stroke patients. Eur Stroke J 5:138\u2013147","journal-title":"Eur Stroke J"},{"key":"13851_CR23","doi-asserted-by":"publisher","first-page":"2832","DOI":"10.1161\/STROKEAHA.110.606665","volume":"42","author":"L Kellert","year":"2011","unstructured":"Kellert L et al (2011) Cerebral oxygen transport failure? Decreasing hemoglobin and hematocrit levels after ischemic stroke predict poor outcome and mortality. Stroke 42:2832\u20132837","journal-title":"Stroke"},{"key":"13851_CR24","doi-asserted-by":"publisher","first-page":"11634","DOI":"10.1038\/s41598-021-91257-5","volume":"11","author":"G Merlino","year":"2021","unstructured":"Merlino G et al (2021) Recanalisation therapy for acute ischemic stroke in cancer patients. Sci Rep 11:11634","journal-title":"Sci Rep"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13851-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-026-13851-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13851-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T17:09:36Z","timestamp":1781370576000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-026-13851-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["13851"],"URL":"https:\/\/doi.org\/10.1007\/s00415-026-13851-9","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,29]]},"assertion":[{"value":"22 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 April 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 May 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 May 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Robin Jansen received travel grants from Alexion, Ipsen and Abbvie which are not related to the submitted work. Tristan K\u00f6lsche received honoraria for lectures from Demecan and Ipsen as well as travel grants from Merck, Abbvie, Ipsen and Merz, which are not related to the submitted work. Robin Jansen received travel grants from Alexion, which are not related to the submitted work. John-Ih Lee is Review Editor for Frontiers in Neurology and received honoraria, travel grants or consultancy fees: Allergan, Abbvie, Ipsen, Novartis, Teva, Lilly, Pfizer, Perfood, Merz and grants from Merz for projects at University Hospital D\u00fcsseldorf\/Heinrich Heine University all outside the submitted work. He is secretary of the board of the working group Botulinumtoxin e. V. of the German Neurological Society. Sven Meuth receives honoraria for lecturing, and travel expenses for attending meetings from Academy 2, Argenx, Alexion, Almirall, Amicus Therapeutics Germany, Bayer Health Care, Biogen, BioNtech, BMS, Celgene, Datamed, Demecan, Desitin, Diamed, Diaplan, DIU Dresden, DPmed, Gen Medicine and Healthcare products, Genzyme, Hexal AG, IGES, Impulze GmbH, Janssen Cilag, KW Medipoint, MedDay Pharmaceuticals, Merck Serono, MICE, Mylan, Neuraxpharm, Neuropoint, Novartis, Novo Nordisk, ONO Pharma, Oxford PharmaGenesis, QuintilesIMS, Roche, Sanofi-Aventis, Springer Medizin Verlag, STADA, Chugai Pharma, Teva, UCB, Viatris, Wings for Life international and Xcenda. His research is funded by the German Ministry for Education and Research (BMBF), Bundesinstitut f\u00fcr Risikobewertung (BfR), Deutsche Forschungsgemeinschaft (DFG), Else Kr\u00f6ner Fresenius Foundation, Gemeinsamer Bundesausschuss (G-BA), German Academic Exchange Service, Hertie Foundation, Interdisciplinary Center for Clinical Studies (IZKF) Muenster, German Foundation Neurology and Alexion, Almirall, Amicus Therapeutics Germany, Biogen, Diamed, DGM e.v., Fresenius Medical Care, Genzyme, Gesellschaft von Freunden und F\u00f6rderern der Heinrich-Heine-Universit\u00e4t D\u00fcsseldorf e.V., HERZ Burgdorf, Merck Serono, Novartis, ONO Pharma, Roche, and Teva.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The local ethics committee of the Heinrich-Heine University Duesseldorf approved the project and study number 2022-2251 in accordance with the STROBE and RECORD guidelines. Due to our registry-only, fully anonymous data approach, no participant consent was needed.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors have read and approved the final version of the manuscript and agree with its submission for publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"347"}}