Smokers Treated for Brain Aneurysm with Coils at Higher Risk of Recurrence
Cigarette
smokers who were treated for cerebral aneurysms with coil embolization
(blocking of a blood vessel) are at greater risk of developing another
aneurysm, say neurological surgeons at Jefferson Hospital for
Neuroscience in Philadelphia in the first-known study of its kind.
In a paper published in the April issue of the Journal of Neurosurgery,
researchers found there was an increased risk of recanalization
(re-opening), especially in low-grade aneurysmal subarrachnoid
hemorrhage (aneurysm) patients with a history of cigarette smoking,
says Erol Veznedaroglu, M.D., associate professor of Neurological
Surgery and director of the Division of Neurovascular Surgery and
Endovascular Neurosurgery at Jefferson Medical College of Thomas
Jefferson University and Thomas Jefferson University Hospital.
“To
our knowledge no study documenting a correlation between aneurysm
recanalization and a history of cigarette smoking history has
previously been reported in the literature,” the authors say.
Annually, aneurysmal subarachnoid hemorrhages are found in
approximately one case per 10,000.
The study’s authors conducted a retrospective chart review of all cases involving patients admitted to their institution for
2003 for treatment of a cerebral aneurysm by coil embolization or coiling.
In
coiling, a catheter is inserted into an artery in the groin, then
advanced into the affected artery in the brain. The surgeon then places
one or more tiny coils through the catheter into the aneurysm. The body
responds by forming a blood clot around the coil, blocking off the
aneurysm.
The
authors searched for any correlation among the location and size of the
treated aneurysm, the incidence of coil compaction, and the history of
smoking as factors for recurrence. But there was no significant
indication that aneurysm location and size, type of coil and packing
density were causing the higher
risk.
“Of
the various factors that lead to a predisposition for these cerebral
aneurysms, cigarette smoking is the only factor that has consistently
been identified in all the populations studied, and is also the most
easily preventable,” says Dr. Veznedaroglu. The quantity of cigarettes
smoked was also found to have an impact on the increased risk of
developing an aneurysm, he adds.
“Cigarette
smoking has been directly correlated with an increased risk of
intracranial aneurysm formation and growth,” the authors say. “And
despite this evidence, more than one third of prior smokers continue to
use nicotine after suffering an aneurysm, especially patients who
started smoking at a young age and those with a history of depression
or alcohol abuse.
However
in the group of patient cases reviewed, the authors did not find a
significant trend between smoking cessation after aneurysm treatment
and the incidence of aneurysm recurrence, but the sample size was not
large enough to demonstrate statistical significance.
“Nevertheless, patients with known cerebral aneurysms should be aggressively counseled about the risk of cigarette smoking,”
Dr. Veznedaroglu says.
Media Only Contact:
Ed Federico
Thomas Jefferson University Hospital
Phone: (215) 955-6300
Published: 3/20/2008