Tobacco cigarette smoking as an intracranial aneurysm risk factor

Tobacco cigarette smoking as an intracranial aneurysm risk factor

Although several studies have suggested that the incidence of intracranial aneurysms (IAs) is higher in smokers, the higher prevalence of subarachnoid hemorrhage (SAH) in smokers remains uncertain. It is unclear whether smoking additionally contributes to the formation of multiple aneurysms and the risk of rupture. The aim of this study was to determine whether smoking is associated with IA formation, multiplicity, or rupture.

Patients from a prospective multicenter @neurIST database (n = 1410; 985 females [69.9%]) were reviewed for the presence of SAH, multiple aneurysms, and smoking status. The prevalence of smokers in the population of patients diagnosed with at least one IA was compared with that of smokers in the general population.

The proportion of smokers was higher in patients with IAs (56.2%) than in the reference population (51.4%; p < 0.001). A significant association of smoking with the presence of an IA was found throughout group comparisons (p = 0.01). The presence of multiple IAs was also significantly associated with smoking (p = 0.003). A trend was found between duration of smoking and the presence of multiple IAs (p = 0.057). However, the proportion of smokers among patients suffering SAH was similar to that of smokers among patients diagnosed with unruptured IAs (p = 0.48).

Smoking is strongly associated with IA formation. Once an IA is present, however, smoking does not appear to increase the risk of rupture compared with IAs in the nonsmoking population. The trend toward an association between duration of smoking and the presence of multiple IAs stresses the need for counseling patients with IAs regarding lifestyle modification 1).


Tobacco cigarette smoking is an independent risk factor for ruptured intracranial aneurysm, and the rupture risk in current smokers is 3× higher than that of nonsmokers 2).


A dose-response relationship has been noted for the 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 3)


Current cigarette smoking, smoking intensity, and smoking duration are significantly associated with ruptured IAs at presentation. However, the significantly increased risk persists after smoking cessation, and smoking cessation does not confer a reduced risk of aneurysmal subarachnoid hemorrhage beyond that of reducing the cumulative dose 4).


Intravenous thrombolysis-treated stroke patients with unruptured intracranial aneurysms were more often current smokers and had higher systolic blood pressure than the matched patients without UIAs. They were as likely to have unfavorable outcomes at 3 months but seemed less likely to achieve excellent outcomes and were more likely to have higher mRS in shift analysis 5).


1)

Schatlo B, Gautschi OP, Friedrich CM, Ebeling C, Jägersberg M, Kulscar Z, Pereira VM, Schaller K, Bijlenga P. Association of single and multiple aneurysms with tobacco abuse: an @neurIST risk analysis. Neurosurg Focus. 2019 Jul 1;47(1):E9. doi: 10.3171/2019.4.FOCUS19130. PubMed PMID: 31261132.
2) , 4)

Can A, Castro VM, Ozdemir YH, Dagen S, Yu S, Dligach D, Finan S, Gainer V, Shadick NA, Murphy S, Cai T, Savova G, Dammers R, Weiss ST, Du R. Association of intracranial aneurysm rupture with smoking duration, intensity, and cessation. Neurology. 2017 Sep 26;89(13):1408-1415. doi: 10.1212/WNL.0000000000004419. Epub 2017 Aug 30. PMID: 28855408; PMCID: PMC5649762.
3)

Feng X, Qian Z, Zhang B, Guo E, Wang L, Liu P, Wen X, Xu W, Jiang C, Li Y, Wu Z, Liu A. Number of Cigarettes Smoked Per Day, Smoking Index, and Intracranial Aneurysm Rupture: A Case-Control Study. Front Neurol. 2018 May 31;9:380. doi: 10.3389/fneur.2018.00380. PMID: 29904368; PMCID: PMC5990590.
5)

Virta JJ, Strbian D, Putaala J, Kaprio J, Korja M. Characteristics and Outcomes of Thrombolysis-Treated Stroke Patients With and Without Saccular Intracranial Aneurysms. Stroke. 2022 Oct 18. doi: 10.1161/STROKEAHA.122.040151. Epub ahead of print. PMID: 36254706.

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