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E-149 The smoking-thrombolysis paradox: a matched case-control study
  1. J Grossberg,
  2. M Bouslama,
  3. D Haussen,
  4. M Frankel,
  5. R Nogueira
  1. Emory, Atlanta, GA


Background and purpose Smoking is a well-established risk factor for stroke. However, several studies have shown that smokers with stroke have better outcomes after thrombolysis, a phenomenon commonly known as the smoking-thrombolysis paradox. We investigated whether clinical and procedural outcomes differ between smokers and non-smokers with large vessel occlusion stroke after endovascular therapy.

Methods We reviewed our prospectively collected endovascular database at a tertiary care academic institution between Sep 2010-December 2016. All patients that underwent endovascular therapy for anterior circulation large vessel occlusion acute ischemic stroke were included and categorized into two groups: (1) current smokers and (2) non-smokers. The 2 groups were then matched for age, baseline NIHSS and glucose levels using a weighted Euclidian distance method. Baseline, procedural, and radiological characteristics, as well as outcome parameters were compared.

Results A total of 326 (163 matched pairs) qualified for the study. Smokers had higher rates of dyslipidemia (48.5% vs 28.8%, p<0.001), lower body mass index (26.7 [23.5–31.3] vs 28.4 [24.9–32.6], p=0.03) and shorter procedures (63[45–82] vs 73.5[46–116], p=0.03). Other baseline characteristics including baseline NIHSS, ASPECT scores, CT Perfusion parameters (ischemic core and penumbra volumes) and median time to treatment were well balanced. When compared with non-smokers, smokers also had similar rates of good outcomes at 90 days (mRS 0–2) (58.2% vs 52.4%, p=0.33), successful reperfusion (mTICI 2b-3) (92% vs 89.6%, p=0.44), parenchymal hematomas (7.4% vs 6.7%, p=0.83) and mortality at 90 days (14.9% vs 15.6%, p=0.86). On multivariate analysis, only successful reperfusion (OR 16.38 95% CI [1.72–155.77], p=0.02), and low 24 hour NIHSS (OR 0.85 95% CI [0.80–0.90],p<0.001) were associated with good outcome.

Conclusion Our data shows that smoking is not associated with outcomes in patients with large vessel occlusion stroke treated with mechanical thrombectomy.

Disclosures J. Grossberg: 1; C; Georgia Research Alliance. 4; C; NTI. M. Bouslama: None. D. Haussen: None. M. Frankel: None. R. Nogueira: None.

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