Association of single and multiple aneurysms with tobacco abuse: an @neurIST risk analysis

Schatlo, Bawarjan; Gautschi, Oliver; Friedrich, Christoph M.; Ebeling, Christian; Jägersberg, Max; Kulscar, Zsolt; Pereira, Vítor Mendes; Schaller, Karl; Bijlenga, Philippe

doi:10.3171/2019.4.focus19130

Cited by 7 publications

(6 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results con rm that smoking cessation or extreme reduction is mandatory advice for patients with diagnosed unruptured brain aneurysms [3,5,9,16,22,23,27,33,39,54]. Nevertheless, the risk of rupture of an already formed aneurysm persists even after quitting smoking [7,42,45]. This is the reason we included former smokers with ruptured or unruptured brain aneurysms in the smoker category, as an aneurysm may have formed many years before smoking cessation.…”

Section: Discussionmentioning

confidence: 70%

Cotinine levels influence the risk of rupture of brain aneurysms

Missori

Sousa

Ambrosone

et al. 2022

Acta Neuro Scandinavica

View full text Add to dashboard Cite

The relationship between nicotine levels in smokers and brain aneurysm has never been determined. To assess the levels of cotinine in smoker patients with ruptured and unruptured brain aneurysm and the risk of aneurysm rupture we quanti ed cotinine levels in smoker patients with ruptured or unruptured brain aneurysms. We identi ed a control group of smokers and nonsmokers without brain aneurysm. Out of 182 participants cerebral aneurysms were statistically signi cantly associated with smoking (P<0.001) and female sex (P=0.006). Cotinine levels were signi cantly correlated with both the presence (P=0.009) and the rupture (P=0.002) of brain aneurysms. Compared with nonsmokers, smokers had a 5-fold higher risk of having a brain aneurysm (OR, 5.72; 95% CI, 2.96-11.07; P<0.001). The risk of rupture of brain aneurysms increased by 50% with each cotinine unit and was 4-fold higher with cotinine levels between 4 and 6 (OR, 3.75; 95% CI, 1.48-9.53; P=0.005). With increasing age, the cotinine level decreased (P <0.001, rho= -0.28), declining by 2% with each year of age. In the whole population, the probability of a ruptured aneurysm in patients with cotinine levels between 4 and 6 was higher than in those with levels between 0 and 3 (OR, 5.55; 95% CI, 1.08-28.5; P=0.040). Our results suggest that high cotinine levels in smokers with brain aneurysm, rather than size, are signi cantly associated with high rupture risk. Cotinine levels decrease with age, possibly reducing the risk of formation and rupture of a brain aneurysm.

show abstract

Section: Discussionmentioning

confidence: 70%

Cotinine levels influence the risk of rupture of brain aneurysms

Missori

Sousa

Ambrosone

et al. 2022

Acta Neuro Scandinavica

View full text Add to dashboard Cite

show abstract

“…Women in Norway have been fully emancipated as smokers for the last 20 years, corresponding to no difference in the fraction of females between our groups of smokers and nonsmokers. Given the association between smoking duration and multiple aneurysm formation [52], the Norwegian smoking emancipation may have contributed to our finding of multiple aneurysms being more common in smokers with a female preponderance. Schatlo et al [52] found a clearly higher risk for [10,19].…”

Section: Patients and Entry Variablesmentioning

confidence: 87%

“…Given the association between smoking duration and multiple aneurysm formation [52], the Norwegian smoking emancipation may have contributed to our finding of multiple aneurysms being more common in smokers with a female preponderance. Schatlo et al [52] found a clearly higher risk for [10,19]. The incidence of aSAH is decreasing in the Nordic countries, possibly due to reduced smoking rates and due to improved treatment of high blood pressure [24,30,33].…”

Section: Patients and Entry Variablesmentioning

confidence: 87%

“…The long-term effect of smoking cessation on aneurysm formation and rupture is not completely clarified. The results of Schatlo et al [52] suggest that the risk of rupture is not reduced when quitting to smoke after the aneurysm has formed and that duration of smoking is important. The latter is in line with the findings of Can et al…”

Section: Management and Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Impact of smoking on course and outcome of aneurysmal subarachnoid hemorrhage

2020

View full text Add to dashboard Cite

Background While the smoking-related risk of experiencing an aneurysmal subarachnoid hemorrhage (aSAH) is well established, it remains unclear whether smoking has an unexpected “protective effect” in aSAH, or if smokers are more at risk for complications and poor outcomes. Methods Prospective, observational study investigating the course and outcome of aSAH in patients admitted during the years 2011 and 2012. Smoking status at admittance, demographic, medical, and radiological variables were registered along with management, complications, and outcome at 1 year in terms of mortality, modified Rankin score, and Glasgow outcome score extended. We compared current smokers with nonsmokers on group level and by paired analysis matched by aSAH severity, age, and severity of vasospasm. Results We included 237 patients, thereof 138 current smokers (58.2%). Seventy-four smoker/nonsmoker pairs were matched. Smokers presented more often in poor clinical grade, had less subarachnoid blood, and were younger than nonsmokers. Ruptured aneurysms were larger, and multiple aneurysms more common in smokers. Severe multi-vessel vasospasm was less frequent in smokers, whereas all other complications occurred at similar rates. Mortality at 30 days was lower in smokers and functional outcome was similar in smokers and nonsmokers. Poor clinical grade, age, cerebral infarction, and vertebrobasilar aneurysms were independent predictors of 1-year mortality and of poor functional outcome. Serious comorbidity was a predictor of 1-year mortality. Smoking did not predict mortality or poor functional outcome. Conclusions Notwithstanding clinically more severe aSAH, smokers developed less frequently severe vasospasm and had better outcome than expected. The risk for complications after aSAH is not increased in smokers.

show abstract

“…Smoking is one of the most important risk factors of cardiovascular disease [ 1 , 2 ]. Compared to non-smokers, smokers had higher risks of cerebral aneurysm formation [ 3 ], rupture [ 4 , 5 ], and vasospasm [ 6 ], and inferior survival rates [ 7 – 9 ] when admitted to hospital because of the acute condition of aneurysmal subarachnoid hemorrhage (aSAH). Globally, 37.1–62% of patients hospitalized with aSAH are active smokers, compared to 22% in the general population [ 10 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Nicotine Replacement Therapy for Smokers with Acute Aneurysmal Subarachnoid Hemorrhage: An International Survey

et al. 2022

Self Cite

View full text Add to dashboard Cite

Introduction Smoking prevalence is twice as high among patients admitted to hospital because of the acute condition of aneurysmal subarachnoid hemorrhage (aSAH) as in the general population. Smoking cessation may improve the prognosis of aSAH, but nicotine replacement therapy (NRT) administered at the time of aSAH remains controversial because of potential adverse effects such as cerebral vasospasm. We investigated the international practice of NRT use for aSAH among neurosurgeons. Methods The online SurveyMonkey software was used to administer a 15-question, 5-min online questionnaire. An invitation link was sent to those 1425 of 1988 members of the European Association of Neurosurgical Societies (EANS) who agreed to participate in surveys to assess treatment strategies for withdrawal of tobacco smoking during aSAH. Factors contributing to physicians’ posture towards NRT were assessed. Results A total of 158 physicians from 50 nations participated in the survey (response rate 11.1%); 68.4% (108) were affiliated with university hospitals and 67.7% (107) practiced at high-volume neurovascular centers with at least 30 treated aSAH cases per year. Overall, 55.7% (88) of physicians offered NRT to smokers with aSAH, 22.1% (35) offered non-NRT support including non-nicotine medication and counselling, while the remaining 22.1% (35) did not actively support smoking cessation. When smoking was not possible, 42.4% (67) of physicians expected better clinical outcomes when prescribing NRT instead of nicotine deprivation, 36.1% (57) were uncertain, 13.9% (22) assumed unaffected outcomes, and 7.6% (12) assumed worse outcomes. Only 22.8% (36) physicians had access to a local smoking cessation team in their practice, of whom half expected better outcomes with NRT as compared to deprivation. Conclusions A small majority of the surveyed physicians of the EANS offered NRT to support smoking cessation in hospitalized patients with aSAH. However, less than half believed that NRT could positively impact clinical outcome as compared to deprivation. This survey demonstrated the lack of consensus regarding use of NRT for hospitalized smokers with aSAH.

show abstract

Association of single and multiple aneurysms with tobacco abuse: an @neurIST risk analysis

Cited by 7 publications

References 36 publications

Cotinine levels influence the risk of rupture of brain aneurysms

Cotinine levels influence the risk of rupture of brain aneurysms

Impact of smoking on course and outcome of aneurysmal subarachnoid hemorrhage

Nicotine Replacement Therapy for Smokers with Acute Aneurysmal Subarachnoid Hemorrhage: An International Survey

Contact Info

Product

Resources

About