BACKGROUND The optimal first‐line device choice for endovascular treatment (EVT) of cancer‐related stroke remains largely unknown. In this study, we evaluated the efficacy and safety of the EVT methods for treating cancer‐related stroke thrombi. METHODS We retrospectively analyzed 78 patients with cancer‐related stroke who underwent EVT between February 2011 and July 2024. Patients were compared based on the first‐line EVT technique (combined [ n = 29] versus stent retriever [SR] only [ n = 35] versus contact aspiration [CA, n = 14]) and the type of the SR (the dual‐layered stent retriever [Embotrap] [ n = 13], the single‐layered stent retriever (Trevo [ n = 16], and the Solitaire [ n = 35]) group. The primary efficacy end point was the first‐pass effect (achieving a modified Thrombolysis in Cerebral Infarction score of 2c or 3 after the first pass). The primary safety end point was the symptomatic intracranial hemorrhage rate. RESULTS The primary efficacy did not differ between the first‐line EVT techniques (first‐pass effect: combined 34.5% versus SR only 17.1% versus CA 35.7%; P = 0.2). Among the SR groups, the dual‐layered stent retriever group showed a higher rate of first‐pass effect compared with the single‐layered stent retriever (Trevo) and the single‐layered stent retriever (Solitaire) groups (53.8% versus 25.0% versus 14.3%, P = 0.023). The dual‐layered stent retriever group was independently associated with a higher rate of first pass effect (adjusted odds ratio, 11.0 [95% CI 1.4–126.0]; P = 0.031). The incidence of symptomatic intracranial hemorrhage after the procedure did not significantly differ between the groups. CONCLUSIONS In EVT for cancer‐related stroke, the dual‐layered stent retriever device demonstrated superior efficacy in higher rates of first‐pass effect without increasing the risk of symptomatic intracranial hemorrhage. These findings suggest that the dual‐layered SR may be preferred as the first‐line treatment option for EVT in cancer‐related stroke.

Background: The effects of blood pressure (BP) lowering in patients treated with intravenous tissue plasminogen activator (IV tPA) before endovascular thrombectomy (EVT) are unclear. Aims: This study aims to investigate whether intensive and conventional BP management affects outcomes differently, depending on IV tPA administration before EVT. Methods: In this subgroup analysis of the Outcome in Patients Treated with Intra-Arterial Thrombectomy–Optimal Blood Pressure Control (OPTIMAL-BP; ClinicalTrials.gov Identifier: NCT04205305) trial, patients were divided into groups based on IV tPA use before EVT. Clinical outcomes of intensive (systolic BP target < 140 mm Hg) or conventional BP management (systolic BP target 140–180 mm Hg) were compared among groups. The primary efficacy outcome was a favorable outcome at 3 months (modified Rankin Scale score of 0–2). Primary safety outcomes included symptomatic intracerebral hemorrhage (sICH) within 36 h and stroke-related death within 3 months. Results: Among the 302 patients, the IV tPA group included 98 (32.5%) and the non-IV tPA group comprised 204 subjects (67.5%). In the IV tPA group, intensive BP management significantly lowered the favorable outcome rate (intensive, 27.3% vs. conventional, 51.9%; adjusted odds ratio [aOR], 0.36; 95% confidence interval [CI], 0.13–0.93; p = 0.04). In the non-IV tPA group, the risk difference rate of favorable outcome was not significantly different between intensive and conventional BP management (44.1% vs. 55.9%; aOR, 0.62; 95% CI, 0.31–1.22; p = 0.17). Notably, the proportion of malignant cerebral edema within 36 h in the IV tPA group was significantly higher in the intensive management group (18.2%) than in the conventional management group (1.9%; aOR, 10.72; 95% CI, 1.24–92.29; p = 0.03). sICH and mortality rates were not significantly different between intensive and conventional BP management in either study groups. Conclusions: Intensive BP management worsens 3-month functional outcomes after successful EVT without reducing sICH among patients who received IV tPA before EVT, indicating that BP lowering in this population should be cautious.