Smoking Impacts on Ischemic Stroke Outcomes

Ischemic stroke results from obstruction of cerebral arteries, leading to brain tissue infarction. Cigarette smoking accelerates atherosclerosis, impairs endothelial function and promotes a pro-thrombotic and pro-inflammatory milieu. As a consequence, smokers face a substantially elevated risk of stroke at a younger age and experience more extensive vascular damage. Paradoxical observations in acute reperfusion settings have suggested that smokers may show higher rates of vessel recanalisation and lower early mortality, but these findings largely reflect differences in age, comorbidity profiles and stroke severity rather than a direct protective effect of tobacco. Comprehensive analyses now indicate that smoking does not confer any genuine benefit on long-term functional recovery and is associated with an earlier onset of stroke by approximately a decade. Smoking cessation remains a cornerstone of both primary and secondary prevention, reducing stroke risk, improving response to treatment and enhancing functional outcomes. Integrating targeted cessation programmes into acute and chronic stroke care pathways is essential to mitigate global stroke burden and optimise patient recovery.

Research from Nature Portfolio

Recent studies have identified smoking as an independent risk factor for poorer outcomes following endovascular thrombectomy. In a multicentre cohort of patients treated between 2017 and 2021, smokers were found to have significantly lower rates of favourable 90-day functional status, as measured by the modified Rankin Scale, even after adjustment for baseline stroke severity and treatment intervals. The analysis highlighted that smokers experienced delayed groin puncture times and elevated baseline NIHSS scores, both of which further compromised recovery. These findings reinforce the importance of smoking cessation and rapid treatment workflows to improve post-stroke prognosis.

Smoking Impacts on Ischemic Stroke Outcomes publication trend

The graph below shows the total number of articles in smoking impacts on ischemic stroke outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Ischemic stroke: A type of stroke caused by blockage of a cerebral artery, leading to tissue infarction.

Endovascular therapy: A minimally invasive procedure to remove or dissolve a clot within a blocked blood vessel in the brain.

National Institutes of Health Stroke Scale (NIHSS): A clinical tool to quantify neurological impairment in stroke patients.

Modified Rankin Scale (mRS): A measure of the degree of disability or dependence in daily activities after stroke.

Recanalisation: Restoration of blood flow through an initially occluded cerebral artery.

Smoker’s paradox: The observation that smokers sometimes appear to have better short-term outcomes in acute cardiovascular or stroke interventions, usually due to confounding factors.

References

1. Clinical predictors of prognosis in stroke patients after endovascular therapy. Scientific Reports (2024).
2. Paradoxical Association of Smoking With In‐Hospital Mortality Among Patients Admitted With Acute Ischemic Stroke. Journal of the American Heart Association (2013).
3. Impact of smoking on stroke outcome after endovascular treatment. PLOS ONE (2018).
4. “Smoking paradox” is not true in patients with ischemic stroke: a systematic review and meta-analysis. Journal of Neurology (2019).