Introduction/Purpose Ischemic stroke is the second leading cause of death in the United States. Smoking accelerates the onset of stroke, on average, by ten years. We sought to analyze the effects of smoking status following endovascular treatment (EVT) for large vessel occlusion in patients with acute ischemic stroke. Through our previously published Blood And Clot Thrombectomy Registry And Collaboration (BACTRAC) stroke tissue bank (ClinicalTrials.gov: NCT03153683), we aimed to determine the effects of smoking on the change in National Institutes of Health Stroke Scale (NIHSS) score, infarct volume, and cerebral edema volume.

Materials and Methods Patients were divided into three groups: current smoker, previous smoker (defined as having quit greater than 6 months prior to the ischemic event), and non-smoker. NIHSS scores were recorded upon admission and at discharge. The change in NIHSS score was defined as score at admission minus the score at discharge. Infarct and cerebral edema volumes were measured. Linear regression analysis was performed based on infarct or edema volume versus the change in NIHSS score.

Results Eighty-eight adult subjects (>18 years) were included in the study, of which 48 (55%) were female. Median age was 69 years (25–101). Twenty-three (26%) were active smokers, 14 (16%) were previous smokers, and 51 (58%) were non-smokers. Mean infarct time, or mean time from last known well, was 508 ± 347 minutes. Mean infarct volume was 67,882 ± 90,632 mm³. Mean edema volume was 69,432 ± 93,878 mm³. Mean NIHSS score on admission was 16.9 ± 7.5 and mean NIHSS score at discharge was 8.9 ± 8.4. Mean age at time of infarct for the smoking population was 10 years earlier when compared to the non-smoking population, 61.9 versus 71.6 years. Linear regression was significant (p<0.0001) when comparing infarct or edema volume versus change in NIHSS score for current smokers only.

Conclusion On average, smokers had stroke 10 years earlier than non-smokers, which is consistent with previously published findings. Smokers also had a statistically significant correlation between infarct or edema volume and worsening change in NIHSS score, when compared to both previous smokers and non-smokers who had no significant correlation. These findings are valuable in patient counseling for smoking cessation. Patients who continue to smoke are more likely to have a stroke earlier in life with potentially more significant disability and worse prognosis.

Disclosures K. Swafford: None. J. Frank: None. J. Roberts: None. A. Trout: None. S. Grupke: None. K. Pennypacker: 6; C; co-owner of Cerelux, LLC. J. Fraser: 2; C; Stream Biomedical, Medtronic, Penumbra. 4; C; Cerelux, LLC, Fawkes Biotechnology. 6; C; owner of Cerelux, LLC, owner of Fawkes Biotechnology.