Aneurysm Recanalisation after Coiling is Affected by Current Cigarette Smoking

Abstract

Background: Cigarette smoking is associated with intracranial aneurysm growth and rupture, but its impact on recanalisation after aneurysm coiling is controversial.\xa0 \n \nMethods: The Analysis of Recanalisation after Endovascular Treatment of intracranial Aneurysm (ARETA) study is a prospective, multicentre cohort study evaluating the association between cigarette smoking and aneurysm recanalisation after endovascular treatment. The current analysis is focused on patients treated by coiling or balloon-assisted coiling (BAC). Patient demographics, aneurysm characteristics, and endovascular techniques were recorded. Postoperative and mid-term vascular imaging were independently evaluated by two neuroradiologists using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. Evolution of aneurysm occlusion was evaluated by directly comparing postoperative and mid-term vascular imaging using a 3-grade scale: improved, stable, and worsened. Recanalisation was defined as any worsening of aneurysm occlusion. \n \nFindings: Between December 2013 and May 2015, 16 French neurointerventional departments enrolled 1289 patients (1359 treated aneurysms). A total of 945 aneurysms in 908 patients were treated with coiling or BAC. The overall rate of aneurysm recanalisation at mid-term follow-up was 29·5% (95% confidence interval [CI] [26·6-32·4]). Multivariate analyses identified one patient factor independently associated with recanalisation: current smoking (36·6% in current smokers versus 24·5% in current non-smokers (Odds ratio [OR] 1·8 [1·3-2·4]; p=0·0001). Two aneurysm factors were also independently associated with recanalisation: ruptured status (31·9% in ruptured aneurysms versus 25·1% in unruptured (OR 1·5 [1·1-2·1]; p=0·006), and size (48·8% in aneurysms ≥10 mm versus 26·5% in aneurysms <10 mm (OR 2·6 [1·8-3·9]; p<0·0001). \n \nInterpretation: Current smoking is associated with higher rate of aneurysm recanalisation after coiling. Patients should be strongly supported to stop smoking after aneurysm coiling. \n \nTrial Registration: The ARETA study was sponsored and entirely funded by the French Ministry of Health in a PHRC (Programme Hospitalier de Recherche Clinique, No. 12-001-0372) and registered on www.clinicaltrials.gov (NCT01942512). \n \nFunding: The study was sponsored and funded by the French Ministry of Health. \n \nDeclaration of Interest: LP reports grants from the French Health Ministry during the study, and personal fees from Balt, Microvention, Phenox, Vesalio, and Perflow outside the submitted work. FE reports personal fees from Biomodex SA consultancy outside the submitted work. GM reports personal fees from Medtronic and Microvention, outside the submitted work. LS reports personal fees from Medtronic, Microvention, and Balt outside the submitted work. PW reports grants from Medtronic, Penumbra, Stryker, and Microvention, and personal fees from Microvention outside the submitted work. All other authors have nothing to disclose. \n \nEthical Approval: ARETA has been approved by the Consultative Committee of Information Processing in Health Care Research Program and the National Commission for Data Processing and Freedom