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000155122 1001_ $$0P:(DE-HGF)0$$aKufner, Anna$$b0
000155122 245__ $$aThe smoking paradox in ischemic stroke patients treated with intra-arterial thrombolysis in combination with mechanical thrombectomy-VISTA-Endovascular.
000155122 260__ $$aSan Francisco, California, US$$bPLOS$$c2021
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000155122 520__ $$aThe smoking-paradox of a better outcome in ischemic stroke patients who smoke may be due to increased efficacy of thrombolysis. We investigated the effect of smoking on outcome following endovascular therapy (EVT) with mechanical thrombectomy alone versus in combination with intra-arterial (IA-) thrombolysis.The primary endpoint was defined by three-month modified Rankin Scale (mRS). We performed a generalized linear model and reported relative risks (RR) for smoking (adjustment for age, sex, hypertension, atrial fibrillation, stroke severity, time to EVT) in patient data stemming from the Virtual International Stroke Trials Archive-Endovascular database.Among 1,497 patients, 740(49.4%) were randomized to EVT; among EVT patients, 524(35.0%) received mechanical thrombectomy alone and 216(14.4%) received it in combination with IA-thrombolysis. Smokers (N = 396) had lower mRS scores (mean 2.9 vs. 3.2; p = 0.02) and mortality rates (10% vs. 17.3%; p<0.001) in univariate analysis. In all patients and in patients treated with mechanical thrombectomy alone, smoking had no effect on outcome in regression analyses. In patients who received IA-thrombolysis (N = 216;14%), smoking had an adjusted RR of 1.65 for an mRS≤1 (95%CI 0.77-3.55). Treatment with IA-thrombolysis itself led to reduced RR for favorable outcome (adjusted RR 0.30); interaction analysis of IA-thrombolysis and smoking revealed that non-smokers with IA-thrombolysis had mRS≤2 in 47 cases (30%, adjusted RR 0.53 [0.41-0.69]) while smokers with IA-thrombolysis had mRS≤2 in 23 cases (38%, adjusted RR 0.61 [0.42-0.87]).Smokers had no clear clinical benefit from EVT that incorporates IA-thrombolysis.
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000155122 650_2 $$2MeSH$$aAged
000155122 650_2 $$2MeSH$$aAtrial Fibrillation: complications
000155122 650_2 $$2MeSH$$aAtrial Fibrillation: physiopathology
000155122 650_2 $$2MeSH$$aEndovascular Procedures: methods
000155122 650_2 $$2MeSH$$aFemale
000155122 650_2 $$2MeSH$$aHumans
000155122 650_2 $$2MeSH$$aHypertension: complications
000155122 650_2 $$2MeSH$$aHypertension: physiopathology
000155122 650_2 $$2MeSH$$aIschemic Stroke: physiopathology
000155122 650_2 $$2MeSH$$aIschemic Stroke: rehabilitation
000155122 650_2 $$2MeSH$$aIschemic Stroke: therapy
000155122 650_2 $$2MeSH$$aMale
000155122 650_2 $$2MeSH$$aMechanical Thrombolysis: methods
000155122 650_2 $$2MeSH$$aMiddle Aged
000155122 650_2 $$2MeSH$$aSmoking: adverse effects
000155122 650_2 $$2MeSH$$aSmoking: physiopathology
000155122 650_2 $$2MeSH$$aThrombectomy: adverse effects
000155122 650_2 $$2MeSH$$aThrombolytic Therapy: methods
000155122 650_2 $$2MeSH$$aTobacco Smoking: adverse effects
000155122 650_2 $$2MeSH$$aTreatment Outcome
000155122 7001_ $$0P:(DE-HGF)0$$aAli, Huma Fatima$$b1
000155122 7001_ $$0P:(DE-HGF)0$$aEbinger, Martin$$b2
000155122 7001_ $$0P:(DE-HGF)0$$aFiebach, Jochen B$$b3
000155122 7001_ $$0P:(DE-HGF)0$$aLiebeskind, David S$$b4
000155122 7001_ $$0P:(DE-2719)2811033$$aEndres, Matthias$$b5
000155122 7001_ $$0P:(DE-HGF)0$$aSiegerink, Bob$$b6
000155122 7001_ $$0P:(DE-HGF)0$$aVISTA-Endovascular Collaborators$$b7$$eCollaboration Author
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