Effect of drug use in the treatment of acute ischemic stroke: A scoping review

Abstract

Background: Drugs of abuse have been associated with ischemic stroke; however, the clinical presentation, outcomes, and treatment data in this population are limited. The overall safety and efficacy of thrombolytic therapy and thrombectomy in these patients remain unclear. This scoping review summarizes published complications and clinical outcomes in patients with recent abuse of cocaine, methamphetamine (MA), cannabis, decongestant, opioids, alcohol, and 3,4-methylenedioxymethamphetamine (MDMA) presenting with acute ischemic stroke. Methods: We conducted a scoping review of the primary literature that assessed outcomes data of thrombolytic therapy or thrombectomy in drug users with acute ischemic stroke. We searched PubMed, Ovid Medline, and Web of Science. Demographic and stroke characteristics, treatment, complications, and clinical outcomes at last follow-up were collected and summarized. Results: We identified 51 studies in this review. Drugs of abuse of interest were cocaine (14 studies), MDMA (one study), MA (eight studies), cannabis (23 studies), alcohol (two studies), decongestants (one study), and opioids (two studies). Clinical presentation and stroke presentation were most commonly described features. Thrombectomy outcomes were reported for four patients total (two studies), all with history of cocaine use. Thrombolysis treatment and outcomes were reported for 8851 patients (five studies) with history of cocaine, alcohol, or cannabis. Both treatments were pursued in three patients (three studies). Treatment complications included intracerebral hemorrhage, vasospasm, and cerebral edema. Conclusion: Evidence for thrombolytic and thrombectomy treatment in drug users remains limited. Controlled studies are needed to examine complication profile and outcomes following thrombolytic and thrombectomy treatment in this population.

Prevention Program for People Living with Stroke in Low and Middle-Income Country: A Systematic Review

“…4 Multi-disciplinary engagement entails the implementation of all levels of stroke prevention measures to patients, ensuring that preventative activities are executed at their highest level of efficiency. 20,21 The study conducted in 38 countries has a diverse viewpoint on the prevention of strokes. The stroke patient who adheres to the prescribed treatment has become a standard in this preventive endeavor.…”

A review of methamphetamine use and stroke in the young

“…While not as common as hemorrhagic stroke, ischemic stroke has been reported as a sequela of both recent and chronic meth use in multiple case series ( 10 , 13 , 64 , 78 ). The incidence of meth-associated ischemic stroke is unknown and represents a current knowledge gap.…”

“…Borrowing from the cardiovascular literature, Khaheshi et al asserted that consideration of aspiration thrombectomy, balloon angioplasty, and/or medical therapies as first line therapies is appropriate when vasospasm or atherosclerotic disease are the favored mechanisms of vessel occlusion ( 93 ). Loewenhardt et al described a chronic meth user who presented with an MCA occlusion that was treated with balloon angioplasty without complication ( 78 , 94 ). Outside of the case presented in this paper, there is no mention of vasospasm as a complication of angiographic interventions in the literature.…”

Cannabis, Cannabinoids, and Stroke: Increased Risk or Potential for Protection—A Narrative Review

“…In a study looking at case reports of young people (mean age: 32 years) who had a stroke, 81% reported cannabis use [25,31]. In another study of 23 case reports of cannabisinduced stroke, the mean age was 28 [32]. Cannabis use in stroke has been found to be much more prevalent in the younger population [1], and cannabis use can be considered as an independent risk factor in stroke for ages 18-55 [33,34].…”