[en] [en] BACKGROUND: Acute ischemic stroke (AIS) is a significant complication of cancer and may reveal occult malignancy. Whether cancer-related AIS (CAS) provides specific biological features remains unclear.
OBJECTIVES: This case-control study aimed to characterize thrombi and plasmas from patients with CAS.
METHODS: Nine consecutive patients with CAS, including 3 nonbacterial thrombotic endocarditis (NBTE), and age- and sex-matched AIS controls with cardioembolism (CE, n = 16) or large artery atherosclerosis (LAA, n = 16) were included from the compoCLOT study. Thrombi retrieved after endovascular thrombectomy underwent ex vivo thrombolysis using recombinant tissue-type plasminogen activator and were analyzed for composition. Plasma biomarkers were also assessed.
RESULTS: CAS thrombi were resistant to tissue-type plasminogen activator lysis compared with LAA thrombi (median thrombus weight conservation, 92% vs 9%; P = .0002) and, to a lesser extent, compared with CE thrombi (92% vs 43%; P = .06). Thrombolysis resistance correlated negatively with red blood cell content (P < .0001) but positively with platelet factor-4 (P = .0014), von Willebrand factor (P = .0002) and DNA content (P < .0001). A subgroup of macroscopically white thrombi (n = 6), characterized by low red blood cell and high von Willebrand factor content, was identified in CAS, encompassing all 3 NBTE cases. Plasma D-dimer, fibrin monomers, extracellular vesicle-associated tissue factor and myeloperoxidase were significantly higher in patients with CAS than in the combined LAA and CE control groups (31,290 vs 1900 µg/L; 143 vs 9 μg/mL; 143 vs 9 fM; and 51 vs 25 ng/mL, respectively).
CONCLUSIONS: CAS thrombi exhibit distinct properties, with white thrombi as a hallmark of undiagnosed NBTE. Furthermore, plasma biomarkers such as D-dimer, fibrin monomers, extracellular vesicle-associated tissue factor and myeloperoxidase could help in cancer screening in AIS of unknown etiology.
Disciplines :
Neurology
Author, co-author :
Habay, Capucine ; Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France ; Hematology laboratory, Bichat Hospital, APHP, Paris, France
Ho-Tin-Noé, Benoît; Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France ; Stroke-Link F-CRIN Research Network, Lille, France
Solo Nomenjanahary, Mialitiana; Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
Ollivier, Véronique; Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
Arab, Ilham; Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France ; Hematology laboratory, Bichat Hospital, APHP, Paris, France
Kabbaj, Lina-Rose; Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France ; Hematology laboratory, Bichat Hospital, APHP, Paris, France
Mazighi, Mikaël; Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France ; Stroke-Link F-CRIN Research Network, Lille, France ; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France ; Department of Neurology, GHU APHP NORD, Lariboisière Hospital, Paris, France ; FHU Neurovasc, Institut Universitaire de France, Paris, France
Ajzenberg, Nadine; Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France ; Hematology laboratory, Bichat Hospital, APHP, Paris, France
Desilles, Jean-Philippe; Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France ; Stroke-Link F-CRIN Research Network, Lille, France ; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
Faille, Dorothée ; Université Paris Cité, Inserm, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France ; Hematology laboratory, Bichat Hospital, APHP, Paris, France
compoCLOT study group∗
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Université de Liège - ULiège > GIGA > GIGA Metabolism & Cardiovascular Biology - Cardiology ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques
Language :
English
Title :
Cancer-associated stroke: a comparative analysis of thrombus composition, resistance to lysis, and plasma biomarkers.
Publication date :
July 2026
Journal title :
Research and Practice in Thrombosis and Haemostasis
INSERM - French Institute of Health and Medical Research ANR - Agence Nationale de la Recherche
Funding text :
FundingThis study was supported by the French National Institute of Health and Medical Research (INSERM) MESSIDORE SAVE-BRAIN and the National Research Agency (ANR-18-RHUS-0001 [RHU Booster] and ANR-22-CE17-0032 [INFLAME]).Authors contributionsC.H., B.H., D.F., and J.-P.D. designed the study. C.H., M.S.N., V.O., I.A., and L.-R.K. performed research. C.H. and D.F. performed data analysis and wrote the manuscript. B.H., J.-P.D., N.A., and M.M. reread the manuscript. M.M. and N.A. supervised the study. All authors read and approved the final manuscript.Relationship DisclosureThere are no competing interests to disclose.Data availabilityData are available upon reasonable request to the corresponding author.
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