Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications - the PLEURA study.
Eur Stroke J
; 8(2): 549-556, 2023 06.
Article
em En
| MEDLINE
| ID: mdl-37231698
ABSTRACT
BACKGROUND:
Computed tomography angiography (CTA) of the supraaortic arteries is commonly used for acute stroke workup and may reveal apical pulmonary lesions (APL).AIM:
To determine the prevalence, follow-up algorithms, and in-hospital outcomes of stroke patients with APL on CTA.METHODS:
We retrospectively included consecutive adult patients with ischemic stroke, transient ischemic attack, or intracerebral hemorrhage and available CTA at a tertiary hospital between January 2014 and May 2021. We reviewed all CTA reports for the presence of APL. APL were classified as malignancy suspicious or benign appearing based on radiological-morphological criteria. We performed regression analyses to investigate the impact of malignancy suspicious APL on different in-hospital outcome parameters.RESULTS:
Among 2715 patients, APL on CTA were found in 161 patients (5.9% [95%CI 5.1-6.9]; 161/2715). Suspicion of malignancy was present in one third of patients with APL (36.0% [95%CI 29.0-43.7]; 58/161), 42 of whom (72.4% [95%CI 60.0-82.2]; 42/58) had no history of lung cancer or metastases. When performed, further investigations confirmed primary or secondary pulmonary malignancy in three-quarters (75.0% [95%CI 50.5-89.8]; 12/16), with two patients (16.7% [95%CI 4.7-44.8]; 2/12) receiving de novo oncologic therapy. In multivariable regression, the presence of radiologically malignancy suspicious APL was associated with higher NIHSS scores at 24 h (beta = 0.67, 95%CI 0.28-1.06, p = 0.001) and all-cause in-hospital mortality (aOR = 3.83, 95%CI 1.29-9.94, p = 0.01).CONCLUSIONS:
One in seventeen patients shows APL on CTA, of which one-third is malignancy suspicious. Further work-up confirmed pulmonary malignancy in a substantial number of patients triggering potentially life-saving oncologic therapy.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Acidente Vascular Cerebral
/
Neoplasias Pulmonares
Tipo de estudo:
Observational_studies
/
Prevalence_studies
/
Risk_factors_studies
Limite:
Adult
/
Humans
Idioma:
En
Revista:
Eur Stroke J
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Suíça