Smoking and Intracranial Aneurysm Morphology

Ho, Allen L.; Lin, Ning; Frerichs, Kai U.; Du, Rose

doi:10.1227/neu.0000000000000735

Cited by 46 publications

(22 citation statements)

References 63 publications

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“…Furthermore, it was observed in the present study that the diagnosis was delayed in current smokers compared with nonsmokers. In contrast, according to Ho et al, 22 in their study, smokers were diagnosed earlier than nonsmokers. This discrepancy between studies can be explained, at least in part, by the fact that in the present study the number of smokers was small.…”

Section: Discussionmentioning

confidence: 55%

Microsurgery of Cerebral Aneurysm: Epidemiological Profile

Ribeiro

Menezes

Madeira

et al. 2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Objectives Intracranial aneurysm consists of localized dilatation of the vascular wall. Its importance includes the fearsome event of rupture and subarachnoid hemorrhage, which presents high morbimortality rates. The present study aimed to analyze the profile and clinical outcome of patients submitted to the microsurgical approach of cerebral aneurysm in the city of Criciúma, state of Santa Catarina, Brazil, from 2015 to 2018. Methods A retrospective observational study was performed, with secondary data collection and a quantitative approach of 47 charts. Results A predominance of females (74.5%) and a mean age of 53 years old (53.53 ± 9.64) was observed. The middle cerebral artery was the most affected vessel (36.2%), with the highest percentage of aneurysms being between 2.1 mm and 7.0 mm (65.9%). There was a correlation between consciousness level and classification on the Hunt-Hess (HH) scale. Patients with Glasgow Coma Scale (GCS) > 7 points had a better prognostic score in the HH scale, and those with GCS ≤ 7 points had a worse prognostic score in the HH scale. Conclusions The present study observed the presence of important risk factors for cerebral aneurysm formation, such as gender, age, smoking, and systemic arterial hypertension. The present study can measure a correlation of the level of consciousness with the HH classification.

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Section: Discussionmentioning

confidence: 55%

Microsurgery of Cerebral Aneurysm: Epidemiological Profile

Ribeiro

Menezes

Madeira

et al. 2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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“…Because cigarette smoke is a mixture of more than 4000 chemicals, the exact mechanisms by which smoking promotes cerebral aneurysm formation remain largely unknown. 13,19,24 Few studies have evaluated how the outcomes after aneurysmal SAH vary by smoking status. In a single-institution study, Lasner et al found that smoking and Fisher Grade 3 were predictors of symptomatic vasospasm.…”

Section: Discussionmentioning

confidence: 99%

Cigarette smoking and outcomes after aneurysmal subarachnoid hemorrhage: a nationwide analysis

Dasenbrock¹,

Rudy²,

Lai³

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Although cigarette smoking is one of the strongest risk factors for cerebral aneurysm development and rupture, there are limited data evaluating the impact of smoking on outcomes after aneurysmal subarachnoid hemorrhage (SAH). Additionally, two recent studies suggested that nicotine replacement therapy was associated with improved neurological outcomes among smokers who had sustained an SAH compared with smokers who did not receive nicotine. METHODS Patients who underwent endovascular or microsurgical repair of a ruptured cerebral aneurysm were extracted from the Nationwide Inpatient Sample (NIS, 2009-2011) and stratified by cigarette smoking. Multivariable logistic regression analyzed in-hospital mortality, complications, tracheostomy or gastrostomy placement, and discharge to institutional care (a nursing or an extended care facility). Additionally, the composite NIS-SAH outcome measure (based on mortality, tracheostomy or gastrostomy, and discharge disposition) was evaluated, which has been shown to have excellent agreement with a modified Rankin Scale score greater than 3. Covariates included in regression constructs were patient age, sex, race/ethnicity, insurance status, socioeconomic status, comorbidities (including hypertension, drug and alcohol abuse), the NIS-SAH severity scale (previously validated against the Hunt and Hess grade), treatment modality used for aneurysm repair, and hospital characteristics. A sensitivity analysis was performed matching smokers to nonsmokers on age, sex, number of comorbidities, and NIS-SAH severity scale score. RESULTS Among the 5784 admissions evaluated, 37.1% (n = 2148) had a diagnosis of tobacco use, of which 31.1% (n = 1800) were current and 6.0% (n = 348) prior tobacco users. Smokers were significantly younger (mean age 51.4 vs 56.2 years) and had more comorbidities compared with nonsmokers (p < 0.001). There were no significant differences in mortality, total complications, or neurological complications by smoking status. However, compared with nonsmokers, smokers had significantly decreased adjusted odds of tracheostomy or gastrostomy placement (11.9% vs 22.7%, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.51-0.78, p < 0.001), discharge to institutional care (OR 0.71, 95% CI 0.57-0.89, p = 0.002), and a poor outcome (OR 0.65, 95% CI 0.55-0.77, p < 0.001). Similar statistical associations were noted in the matched-pairs sensitivity analysis and in a subgroup of poor-grade patients (the upper quartile of the NIS-SAH severity scale). CONCLUSIONS In this nationwide study, smokers experienced SAH at a younger age and had a greater number of comorbidities compared with nonsmokers, highlighting the negative ramifications of cigarette smoking among patients with cerebral aneurysms. However, smoking was also associated with paradoxical superior outcomes on some measures, and future research to confirm and further understand the basis of this relationship is needed.

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“…Our results are congruent with the basic research findings that the effects of cigarette smoke on endothelial cells are only functional initially, while the endothelial-cell layer exhibits physical damage and can even be completely destroyed by chronic exposure of cigarette smoke (increase of smoking index) ( 22 ). Moreover, increasing degrees of smoking may be more permissive to accelerate morphological changes of aneurysms ( 23 ). These changes, in turn, may increase the eventual rupture risk of the aneurysm.…”

Section: Discussionmentioning

confidence: 99%

Number of Cigarettes Smoked Per Day, Smoking Index, and Intracranial Aneurysm Rupture: A Case–Control Study

et al. 2018

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Background and purposeWe aimed to investigate the effect of smoking on the risk of intracranial aneurysm (IA) rupture (IAR), specifically relationship between the number of cigarettes smoked per day (CPD) or smoking index and the risk of IAR.MethodsWe performed a single-center case–control study of consecutive patients evaluated or treated for IA at our institution from June 2015 to July 2016. Cases were patients with a ruptured IA. Two age- and sex-matched controls with an unruptured IA were included per case. Conditional logistic regression models were used to assess the relationship between both the CPD and smoking index (CPD × years of smoking) and IAR.ResultsThe study population included 127 cases of IAR and 254 controls. The higher IAR risk was associated with cigarette smoking (both current and former) (OR, 2.3; 95% CI, 1.1–4.8; P = 0.029). Our subgroup analysis of smokers revealed a significant association between IAR risk and current smoking (OR, 2.8; 95% CI, 1.2–6.3; P = 0.012), current heavy smoking (CPD ≥ 20) (OR, 3.9; 95% CI, 1.4–11.0; P = 0.007), and a smoking index ≥800 (OR, 11.4; 95% CI, 2.3–24.5; P = 0.003). Former smoking was not significantly associated with IAR (OR, 1.1; 95% CI, 0.3–4.0; P = 0.929).ConclusionA dose–response relationship has been noted for intensity and duration of smoking consumption and increased risk of IAR. As smoking is modifiable, this finding is important to managing patients with IAs to quit or reduce smoking prior to life-threatening subarachnoid hemorrhage.

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Smoking and Intracranial Aneurysm Morphology

Cited by 46 publications

References 63 publications

Microsurgery of Cerebral Aneurysm: Epidemiological Profile

Microsurgery of Cerebral Aneurysm: Epidemiological Profile

Cigarette smoking and outcomes after aneurysmal subarachnoid hemorrhage: a nationwide analysis

Number of Cigarettes Smoked Per Day, Smoking Index, and Intracranial Aneurysm Rupture: A Case–Control Study

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