Three-territory sign in cancer-related ischemic stroke

Abstract

Background & Objective: The presence of multiple acute infarcts in stroke patients indicates cardioembolism in etiology. However, it has also been proposed that 3-territory sign (TTS) with infarction in three different vascular teritories is a radiological marker for cancer. In this study, we aimed to examine TTS in stroke patients with cancer comorbidity as compared to control.

Methods: Among the patients who were hospitalized with the diagnosis of acute stroke between 2017-2022, 68 patients with a history of cancer were included in this study. Age, sex, medication, vascular risk factors (RF), cancer type, Bamford and TOAST classification, National Institute of Health Stroke Score (NIHSS), modified Rankin Score (mRS) and TTS as imaging findings were recorded. As the control group (CG), 47 stroke patients matched for age, sex, medication and RF were included.

Results: The most common cancer types were gastrointestinal system, breast and lung, respectively. There was a significant difference between the two groups in terms of Bamford classification and NIHSS. 64.7% of the CaG had infarction in 1 territory, 13.2% in 2 and 13.2% in 3 territories. While 83% of CG had infarction in 1 territory, 14.9% in 2 territories, there were no participants with infarction in 3 territories (p=0.02). After exclusion of the patients with cardioembolic etiology, 14% of CaG had TTS, while no patient had TTS in CG (p=0.047).

Conclusion: Our study supports the finding of TTS in cancer-related stroke, even after excluding cardioembolic etiologies.