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@ARTICLE{Kufner:155122,
      author       = {Kufner, Anna and Ali, Huma Fatima and Ebinger, Martin and
                      Fiebach, Jochen B and Liebeskind, David S and Endres,
                      Matthias and Siegerink, Bob},
      collaboration = {VISTA-{Endovascular Collaborators}},
      title        = {{T}he smoking paradox in ischemic stroke patients treated
                      with intra-arterial thrombolysis in combination with
                      mechanical thrombectomy-{VISTA}-{E}ndovascular.},
      journal      = {PLOS ONE},
      volume       = {16},
      number       = {5},
      issn         = {1932-6203},
      address      = {San Francisco, California, US},
      publisher    = {PLOS},
      reportid     = {DZNE-2021-00443},
      pages        = {e0251888},
      year         = {2021},
      abstract     = {The 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.},
      keywords     = {Aged / Atrial Fibrillation: complications / Atrial
                      Fibrillation: physiopathology / Endovascular Procedures:
                      methods / Female / Humans / Hypertension: complications /
                      Hypertension: physiopathology / Ischemic Stroke:
                      physiopathology / Ischemic Stroke: rehabilitation / Ischemic
                      Stroke: therapy / Male / Mechanical Thrombolysis: methods /
                      Middle Aged / Smoking: adverse effects / Smoking:
                      physiopathology / Thrombectomy: adverse effects /
                      Thrombolytic Therapy: methods / Tobacco Smoking: adverse
                      effects / Treatment Outcome},
      cin          = {AG Endres},
      ddc          = {610},
      cid          = {I:(DE-2719)1811005},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34014988},
      pmc          = {pmc:PMC8136663},
      doi          = {10.1371/journal.pone.0251888},
      url          = {https://pub.dzne.de/record/155122},
}