Dataset Information

Association of intracranial aneurysm rupture with smoking duration, intensity, and cessation.

ABSTRACT:

Objective

Although smoking is a known risk factor for intracranial aneurysm (IA) rupture, the exact relationship between IA rupture and smoking intensity and duration, as well as duration of smoking cessation, remains unknown.

Methods

In this case-control study, we analyzed 4,701 patients with 6,411 IAs diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016. We divided individuals into patients with ruptured aneurysms and controls with unruptured aneurysms. We performed univariable and multivariable logistic regression analyses to determine the association between smoking status and ruptured IAs at presentation. In a subgroup analysis among former and current smokers, we assessed the association between ruptured aneurysms and number of packs per day, duration of smoking, and duration since smoking cessation.

Results

In multivariable analysis, current (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.89-2.59) and former smoking status (OR 1.56, 95% CI 1.31-1.86) were associated with rupture status at presentation compared with never smokers. In a subgroup analysis among current and former smokers, years smoked (OR 1.02, 95% CI 1.01-1.03) and packs per day (OR 1.46, 95% CI 1.25-1.70) were significantly associated with ruptured aneurysms at presentation, whereas duration since cessation among former smokers was not significant (OR 1.00, 95% CI 0.99-1.02).

Conclusions

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.

SUBMITTER: Can A

PROVIDER: S-EPMC5649762 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Highlights • In our department of neurosurgery, we noticed a higher rate of patients with ruptured aneurysm who had a deteriorated neurological presentation on admission during COVID-19 pandemic (2020 group, n?=?26).• A group control included 28 consecutive patients managed at the same institution for the same disease in 2019, during the same time frame (2019 group).• Rates of poor neurological presentation and severe radiological presentation on hospital admission were higher during COVID-19 pandemic (p?=?0.01 and p?=?0.02, respectively).• During COVID-19 pandemic (2020 group), the delayed hospital admission was longer (p?=?0.005). Therefore, vasospasm’s rate on presentation was also higher (p?=?0.04).• In 2020, patients with only sudden headache may have feared immediate hospital admission because of potential COVID-19 contamination.• In case of recurrent COVID-19 pandemic, educating the population concerning specific symptoms such as sudden headache, neurological deficit or even sudden chest pain should be emphasized. Background/objectives The present study aimed at evaluating the impact on the early outcome of patients with ruptured intracranial aneurysms. Methods Our study prospectively included 26 consecutive patients with ruptured intracranial aneurysm managed at our institution in context of COVID-19 pandemic between March 1st, 2020 and April, 26th, 2020 (2020 group). A group control included other 28 consecutive patients managed at the same institution for the same disease in 2019, during the same time frame (2019 group). On admission, poor neurological status was defined as WFNS score >3. Severe radiological status was defined by the presence of intracerebral hematoma, or/and acute hydrocephalus requiring further EVD or/and the presence of vasospasm on presentation. Statistical analysis was performed to compare the 2 distinct groups. Results Rates of poor neurological presentation and severe radiological presentation on hospital admission were higher in the 2020 group (p?=?0.01 and p?=?0.02, respectively). The delayed hospital admission was 2.7 days in 2020 group and 0.75 days in 2019 group (p?=?0.005). Therefore, vasospasm’s rate on presentation was also higher in the 2020 group (p?=?0.04). Conclusion To our knowledge, this is one of the first studies demonstrating influence of the COVID-19 pandemic on patients with urgent and severe intracranial aneurysmal disease. In case of recurrent COVID-19 pandemic, educating the population concerning specific symptoms such as sudden headache, neurological deficit or even sudden chest pain should be emphasized.