The smoking paradox in ischemic stroke patients treated with intra-arterial thrombolysis in combination with mechanical thrombectomy–VISTA-Endovascular

Autor: Anna Kufner, Huma Fatima Ali, Martin Ebinger, Jochen B Fiebach, David S Liebeskind, Matthias Endres, Bob Siegerink, VISTA-Endovascular Collaborators
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
methods [Mechanical Thrombolysis]
Physiology
adverse effects [Tobacco Smoking]
Social Sciences
Cardiovascular Medicine
Vascular Medicine
Habits
Mathematical and Statistical Techniques
Medical Conditions
physiopathology [Smoking]
physiopathology [Hypertension]
Atrial Fibrillation
Smoking Habits
Medicine and Health Sciences
Psychology
Thrombolytic Therapy
complications [Hypertension]
Thrombectomy
Endovascular Procedures
Smoking
Statistics
adverse effects [Thrombectomy]
therapy [Ischemic Stroke]
Middle Aged
Stroke
intra-arterial thrombolysis
Treatment Outcome
Neurology
Cardiovascular Diseases
Hypertension
Physical Sciences
Medicine
Regression Analysis
Female
600 Technik
Medizin
angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
Arrhythmia
Research Article
complications [Atrial Fibrillation]
Drug Research and Development
Mechanical Thrombolysis
Death Rates
Science
Cerebrovascular Diseases
Cardiology
smokers
Research and Analysis Methods
mechanical thrombectomy
Population Metrics
Tobacco Smoking
Humans
Clinical Trials
ddc:610
Statistical Methods
Aged
Ischemic Stroke
Pharmacology
Behavior
endovascular therapy
Population Biology
physiopathology [Ischemic Stroke]
adverse effects [Smoking]
Biology and Life Sciences
methods [Thrombolytic Therapy]
Cardiovascular Disease Risk
physiopathology [Atrial Fibrillation]
Randomized Controlled Trials
rehabilitation [Ischemic Stroke]
Reperfusion
Clinical Medicine
Physiological Processes
methods [Endovascular Procedures]
Mathematics
Zdroj: PLoS ONE
PLOS ONE 16(5), e0251888-(2021). doi:10.1371/journal.pone.0251888
PLoS ONE, Vol 16, Iss 5, p e0251888 (2021)
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0251888
Popis: Background: The smoking-paradox of a better outcome in ischemic stroke patients who smoke may be due to increased efficacy of thrombolysis. We investigated the effect of smoking on outcome following endovascular therapy (EVT) with mechanical thrombectomy alone versus in combination with intra-arterial (IA-) thrombolysis. Methods: The primary endpoint was defined by three-month modified Rankin Scale (mRS). We performed a generalized linear model and reported relative risks (RR) for smoking (adjustment for age, sex, hypertension, atrial fibrillation, stroke severity, time to EVT) in patient data stemming from the Virtual International Stroke Trials Archive-Endovascular database. Results: Among 1,497 patients, 740(49.4%) were randomized to EVT; among EVT patients, 524(35.0%) received mechanical thrombectomy alone and 216(14.4%) received it in combination with IA-thrombolysis. Smokers (N = 396) had lower mRS scores (mean 2.9 vs. 3.2; p = 0.02) and mortality rates (10% vs. 17.3%; p1 (95%CI 0.77-3.55). Treatment with IA-thrombolysis itself led to reduced RR for favorable outcome (adjusted RR 0.30); interaction analysis of IA-thrombolysis and smoking revealed that non-smokers with IA-thrombolysis had mRS ≤ 2 in 47 cases (30%, adjusted RR 0.53 [0.41-0.69]) while smokers with IA-thrombolysis had mRS ≤ 2 in 23 cases (38%, adjusted RR 0.61 [0.42-0.87]). Conclusions: Smokers had no clear clinical benefit from EVT that incorporates IA-thrombolysis.
Databáze: OpenAIRE
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