Neurointervention.  2019 Mar;14(1):43-52. 10.5469/neuroint.2018.01123.

Cigarette Smoking Preferentially Affects Intracranial Vessels in Young Males: A Propensity-Score Matching Analysis

• Song Y
• Lee D
• Suh DC
• Kim JG
• Kim JK
• Han M
• Liu H
• Zhao L
• Kim EH
• Jung SC
• Lee DG
• Koo HJ
• Kim MJ
• Baek S
• Hwang SM
• Kim BJ
• Kim YJ
• Cho HJ
• Kim SJ
• Jeon SB
• Kim JS

• KMID: 2446781
• DOI: http://doi.org/10.5469/neuroint.2018.01123

Abstract

PURPOSE
Cigarette smoking (CS) is one of the major risk factors of cerebral atherosclerotic disease, however, its level of contribution to extracranial and intracranial atherosclerotic stenosis (ECAS and ICAS) was not fully revealed yet. The purpose of our study was to assess the association of CS to cerebral atherosclerosis along with other risk factors.
MATERIALS AND METHODS
All consecutive patients who were angiographically confirmed with severe symptomatic cerebral atherosclerotic disease between January 2002 and December 2012 were included in this study. Multivariate logistic regression analyses were performed to identify risk factors for ECAS and ICAS. Thereafter, CS group were compared to non-CS group in the entire study population and in a propensity-score matched population with two different age-subgroups.
RESULTS
Of 1709 enrolled patients, 794 (46.5%) had extracranial (EC) lesions and the other 915 (53.5%) had intracranial (IC) lesions. CS group had more EC lesions (55.8% vs. 35.3%, P<0.001) whereas young age group (<50 years) had more IC lesion (84.5% vs. 47.6%, P<0.001). In multivariate analysis, seven variables including CS, male, old age, coronary heart disease, higher erythrocyte sedimentation rate, multiple lesions, and anterior lesion were independently associated with ECAS. In the propensity-score matched CS group had significant more EC lesion compared to non-CS group (65.7% vs. 47.9%) only in the old age subgroup.
CONCLUSION
In contrast to a significant association between CS and severe symptomatic ECAS shown in old population, young patients did not show this association and showed relatively higher preference of ICAS.

Keyword

Atherosclerosis; Risk factors; Cerebrovascular circulation; Smoking

MeSH Terms

Atherosclerosis
Blood Sedimentation
Cerebrovascular Circulation
Constriction, Pathologic
Coronary Disease
Humans
Intracranial Arteriosclerosis
Logistic Models
Male*
Multivariate Analysis
Risk Factors
Smoking*
Tobacco Products*

Figure

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  Fig. 1. Angiographic definition of the anatomical border between intracranial and extracranial arteries. The petro-cavernous segment (dotted portion) of the internal carotid artery exists between the intradural and extracranial arteries. The intracranial artery consists of the intradural artery and petro-cavernous segment of the internal carotid artery.

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  Fig. 2. Distribution of propensity scores in the young (<50 years; A) and old (≥50 years; B) age groups. Left histograms (raw smoker and raw non-smoker) in each group are before score matching and right histograms (matched smoker and matched non-smoker) are after score matching. Upper histograms (raw smoker and matched smoker) are smoker groups and lower histograms (raw non-smoker and matched non-smoker) are non-smoker groups. Before matching (raw) smoker groups have significantly higher propensity scores than the non-smoker groups in both age groups. After matching the density distributions between the smoker and non-smoker become somewhat similar in both age groups.

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  Fig. 3. Number of patients for different locations of the atherosclerotic stenosis (extracranial vs. intracranial) in the total, young (<50), and old (≥50) groups before propensity-score matching.

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  Fig. 4. Number of patients for different locations of the atherosclerotic stenosis (extracranial vs. intracranial) in the total, young (<50), and old (≥50) groups after propensity-score matching.

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