Smokers with Large Vessel Occlusion Stroke Show Poor Leptomeningeal Collaterals
7 affiliations
- 1From the Department of Neurology (H.B., L.B.O., G.M.G., C.L., M.E.A., M.G., S.W.), University Hospital Zurich and University of Zurich, Zurich, Switzerland
- 2Department of Neuroradiology (F.M.), EOC Ospedale Regionale di Lugano, Lugano, Switzerland
- 3Neuroscience Center Zurich (C.L., M.E.A., P.T., Z.K., S.W.), ETH and University of Zurich, Zurich, Switzerland
- 4ARTORG Center for Biomedical Engineering Research (C.L.), University of Berne, Berne, Switzerland
- 5Department of Clinical Research (S.P., T.D.D.), University of Basel, Basel, Switzerland
- 6Department of Neurology and Stroke Center (S.P., T.D.D.), University Teaching and Research Hospital, Health Eastern Switzerland (HOCH), Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- 7Department of Neuroradiology (P.T., Z.K.), University Hospital Zurich, Zurich, Switzerland
Abstract
BACKGROUND AND PURPOSE: In ischemic stroke, the collateral circulation influences tissue survival, but the factors that affect collateral function remain understudied. Smoking is a major vascular risk factor, yet some studies have suggested a smokers' paradox, with increased resilience of the brain's vascular network and better outcomes in patients with a positive smoking history. Here, we aimed to assess associations between smoking and leptomeningeal collateral status using DSA, the reference standard for collateral evaluation. MATERIALS AND METHODS: We retrospectively analyzed data from 921 patients with confirmed vessel occlusion from our multicenter stroke image and clinical data repository. Leptomeningeal collaterals were graded based on DSA. Smoking status was classified as never versus former or current smoker. Univariate and multivariate analyses were used to investigate the associations between smoking and collateral status, adjusting for relevant clinical features. RESULTS: Three hundred fifty-seven patients were included in the analysis (53% women)-19% were current or former smokers. Patients with stroke with a positive smoking history were significantly younger and less likely to have atrial fibrillation. In unadjusted and adjusted logistic regression analysis, smokers had significantly lower odds of having a good collateral status on DSA with an unadjusted OR of 0.43 (95% CI, 0.24-0.75) and an adjusted OR of 0.42 (95% CI, 0.23-0.76). CONCLUSIONS: DSA-based assessment demonstrated a significant association between positive smoking history and worse collateral status. These findings contradict prior CTA-based studies and the smokers' paradox hypothesis.
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BibTeX
@article{baazaoui2026smokers,
title = {{Smokers with Large Vessel Occlusion Stroke Show Poor Leptomeningeal Collaterals}},
author = {Hakim Baazaoui and Francesco Morra and Lukas Bastian Otto and Gabriele Maria Gassner and Chryso Lambride and Mohamad El Amki and Marius Güntert and Samil Pakmak and Tolga D. Dittrich and Patrick Thurner and Zsolt Kulcsar and Susanne Wegener},
journal = {AJNR: American Journal of Neuroradiology},
year = {2026},
month = nov,
doi = {10.3174/ajnr.a9320},
url = {https://doi.org/10.3174/ajnr.a9320},
note = {CC BY},
}
RIS
TY - JOUR
TI - Smokers with Large Vessel Occlusion Stroke Show Poor Leptomeningeal Collaterals
AU - Hakim Baazaoui
AU - Francesco Morra
AU - Lukas Bastian Otto
AU - Gabriele Maria Gassner
AU - Chryso Lambride
AU - Mohamad El Amki
AU - Marius Güntert
AU - Samil Pakmak
AU - Tolga D. Dittrich
AU - Patrick Thurner
AU - Zsolt Kulcsar
AU - Susanne Wegener
PY - 2026
DA - 2026/11/06
JO - AJNR: American Journal of Neuroradiology
DO - 10.3174/ajnr.a9320
UR - https://doi.org/10.3174/ajnr.a9320
AB - BACKGROUND AND PURPOSE: In ischemic stroke, the collateral circulation influences tissue survival, but the factors that affect collateral function remain understudied. Smoking is a major vascular risk factor, yet some studies have suggested a smokers' paradox, with increased resilience of the brain's vascular network and better outcomes in patients with a positive smoking history. Here, we aimed to assess associations between smoking and leptomeningeal collateral status using DSA, the reference standard for collateral evaluation. MATERIALS AND METHODS: We retrospectively analyzed data from 921 patients with confirmed vessel occlusion from our multicenter stroke image and clinical data repository. Leptomeningeal collaterals were graded based on DSA. Smoking status was classified as never versus former or current smoker. Univariate and multivariate analyses were used to investigate the associations between smoking and collateral status, adjusting for relevant clinical features. RESULTS: Three hundred fifty-seven patients were included in the analysis (53% women)-19% were current or former smokers. Patients with stroke with a positive smoking history were significantly younger and less likely to have atrial fibrillation. In unadjusted and adjusted logistic regression analysis, smokers had significantly lower odds of having a good collateral status on DSA with an unadjusted OR of 0.43 (95% CI, 0.24-0.75) and an adjusted OR of 0.42 (95% CI, 0.23-0.76). CONCLUSIONS: DSA-based assessment demonstrated a significant association between positive smoking history and worse collateral status. These findings contradict prior CTA-based studies and the smokers' paradox hypothesis.
SN - 0195-6108
SN - 1936-959X
ER -