Impact of Smoking on Stroke Outcome After Endovascular Treatment

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 May 3

PMID 29718909

Citations 11

Authors

Rascha von Martial

Jan Gralla

Pasquale Mordasini

Marwan El Koussy

Sebastian Bellwald

Bastian Volbers

Rebekka Kurmann

Simon Jung

Urs Fischer

Marcel Arnold

Hakan Sarikaya

Affiliations

Soon will be listed here.

Abstract

Background: Recent studies suggest a paradoxical association between smoking status and clinical outcome after intravenous thrombolysis (IVT). Little is known about relationship between smoking and stroke outcome after endovascular treatment (EVT).

Methods: We analyzed data of all stroke patients treated with EVT at the tertiary stroke centre of Berne between January 2005 and December 2015. Using uni- and multivariate modeling, we assessed whether smoking was independently associated with excellent clinical outcome (modified Rankin Scale (mRS) 0-1) and mortality at 3 months. In addition, we also measured the occurrence of symptomatic intracranial hemorrhage (sICH) and recanalization.

Results: Of 935 patients, 204 (21.8%) were smokers. They were younger (60.5 vs. 70.1 years of age, p<0.001), more often male (60.8% vs. 52.5%, p = 0.036), had less often from hypertension (56.4% vs. 69.6%, p<0.001) and were less often treated with antithrombotics (35.3% vs. 47.7%, p = 0.004) as compared to nonsmokers. In univariate analyses, smokers had higher rates of excellent clinical outcome (39.1% vs. 23.1%, p<0.001) and arterial recanalization (85.6% vs. 79.4%, p = 0.048), whereas mortality was lower (15.6% vs. 25%, p = 0.006) and frequency of sICH similar (4.4% vs. 4.1%, p = 0.86). After correcting for confounders, smoking still independently predicted excellent clinical outcome (OR 1.758, 95% CI 1.206-2.562; p<0.001).

Conclusion: Smoking in stroke patients may be a predictor of excellent clinical outcome after EVT. However, these data must not be misinterpreted as beneficial effect of smoking due to the observational study design. In view of deleterious effects of cigarette smoking on cardiovascular health, cessation of smoking should still be strongly recommended for stroke prevention.

Citing Articles

Effect of smoking status on clinical outcomes after reperfusion therapy for acute ischemic stroke.

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Smoke Signals: Unraveling the Paradoxical Impact of Smoking on Stroke Prognosis and Treatment Efficacy.

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Clinical predictors of prognosis in stroke patients after endovascular therapy.

Wang Y, Yuan X, Kang Y, Yu L, Chen W, Fan G Sci Rep. 2024; 14(1):667.

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Machine learning to predict futile recanalization of large vessel occlusion before and after endovascular thrombectomy.

Lin X, Zheng X, Zhang J, Cui X, Zou D, Zhao Z Front Neurol. 2022; 13:909403.

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Impact of Stroke Severity on the Smoking Paradox in Patients Treated with Intravenous Thrombolysis.

Zhang P, Guo Z, Yan X, Zhang F, Yang Y Curr Neurovasc Res. 2022; 19(2):203-209.

PMID: 35638544 DOI: 10.2174/1567202619666220530092614.

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