Impact of smoking on stroke outcome after endovascular treatment.

von Martial, Rascha; Gralla, Jan; Mordasini, Pasquale; El-Koussy, Marwan; Bellwald, Sebastian; Volbers, Bastian; Kurmann, Rebekka; Jung, Simon; Fischer, Urs; Arnold, Marcel; Sarikaya, Hakan (2018). Impact of smoking on stroke outcome after endovascular treatment. PLoS ONE, 13(5), e0194652. Public Library of Science 10.1371/journal.pone.0194652

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Recent studies suggest a paradoxical association between smoking status and clinical outcome after intravenous thrombolysis (IVT). Little is known about relationship between smoking and stroke outcome after endovascular treatment (EVT).


We analyzed data of all stroke patients treated with EVT at the tertiary stroke centre of Berne between January 2005 and December 2015. Using uni- and multivariate modeling, we assessed whether smoking was independently associated with excellent clinical outcome (modified Rankin Scale (mRS) 0-1) and mortality at 3 months. In addition, we also measured the occurrence of symptomatic intracranial hemorrhage (sICH) and recanalization.


Of 935 patients, 204 (21.8%) were smokers. They were younger (60.5 vs. 70.1 years of age, p<0.001), more often male (60.8% vs. 52.5%, p = 0.036), had less often from hypertension (56.4% vs. 69.6%, p<0.001) and were less often treated with antithrombotics (35.3% vs. 47.7%, p = 0.004) as compared to nonsmokers. In univariate analyses, smokers had higher rates of excellent clinical outcome (39.1% vs. 23.1%, p<0.001) and arterial recanalization (85.6% vs. 79.4%, p = 0.048), whereas mortality was lower (15.6% vs. 25%, p = 0.006) and frequency of sICH similar (4.4% vs. 4.1%, p = 0.86). After correcting for confounders, smoking still independently predicted excellent clinical outcome (OR 1.758, 95% CI 1.206-2.562; p<0.001).


Smoking in stroke patients may be a predictor of excellent clinical outcome after EVT. However, these data must not be misinterpreted as beneficial effect of smoking due to the observational study design. In view of deleterious effects of cigarette smoking on cardiovascular health, cessation of smoking should still be strongly recommended for stroke prevention.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

von Martial, Rascha, Gralla, Jan, Mordasini, Pasquale Ranato, El-Koussy, Marwan, Bellwald, Sebastian, Volbers, Bastian, Kurmann, Rebekka, Jung, Simon, Fischer, Urs Martin, Arnold, Marcel, Sarikaya, Hakan


600 Technology > 610 Medicine & health




Public Library of Science




Martin Zbinden

Date Deposited:

09 May 2018 12:01

Last Modified:

02 Mar 2023 23:30

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