Smoking Does Not Affect Occlusion Rates and Morbidity-Mortality after Pipeline Embolization for Intracranial...

Smoking is a major risk factor for patients with intracranial aneurysms, yet the effects of smoking on outcomes of aneurysm with flow-diverter treatment remain unknown. We studied the impact of smoking on long-term angiographic and clinical outcomes after flow-diverter treatment of intracranial aneurysms.

We retrospectively reviewed data from patients treated with the Pipeline Embolization Device and included in the International Retrospective Study of the Pipeline Embolization Device, the Pipeline for Uncoilable or Failed Aneurysms Study, and the Aneurysm Study of Pipeline in an Observational Registry. Patients were stratified according to smoking status into 3 groups: 1) never smoker, 2) current smoker, and 3) former smoker. We studied angiographic and clinical outcomes. Outcomes were compared by using χ(2) and Student t tests. A multivariate analysis was performed to determine whether smoking was independently associated with poor outcomes.

Six hundred sixteen patients with 694 aneurysms were included. Current smokers had a smaller mean aneurysm size compared with the other 2 groups (P = .005) and lower rates of multiple Pipeline Embolization Device use (P = .015). On multivariate analysis, former smokers (OR, 1.08; 95% CI, 0.43-2.71; P = .57) and current smokers (OR, 0.70; 95% CI, 0.27-1.77; P = .38) had similar odds of long-term angiographic incomplete occlusion compared with never smokers. Former smokers (OR, 1.27; 95% CI, 0.64-2.52; P = .25) and current smokers (OR, 0.74; 95% CI, 0.37-1.46; P = .22) had similar odds of major morbidity and neurologic mortality compared with never smokers.

These results suggest that smoking is not associated with angiographic and clinical outcomes among patients treated with the Pipeline Embolization Device. Nonetheless, patients with intracranial aneurysms should continue to be counseled about the risks of tobacco smoking.