Revisiting the Etiology of Cocaine-Related Ischemic Strokes: An Observational Cohort

Chronic cocaine use increases the odds of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, while additionally increasing overall mortality risk. 1 The proposed mechanism of vasospasm causing small vessel occlusion in the brain has been credited as the culprit behind acute ischemic strokes (AIS) in patients who use cocaine. 2 Few studies have confirmed these unique stroke mechanisms associated with acute and chronic cocaine use, and further validation is required. 3Additionally, the safety of using combination thrombolytic therapy and endovascular thrombectomy (EVT) in these patients has not been well-studied. 4nderstanding the unique causes of cerebral infarction associated with cocaine use may inform future treatment decisions and provide evidence supporting the use of acute reperfusion therapies, such as EVT, in this population.This retrospective observational cohort study was conducted at a comprehensive stroke center between January 2021 and May 2022.Approval for this study was granted through the institutional review board (IRB#21-1903) with a waiver of informed consent.Patients were required to have a primary diagnosis of AIS and a positive urine toxicology test for cocaine.Patient demographics, substance use history, urine toxicology upon admission, stroke type (hemorrhagic vs. ischemic), TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria classification, 5 past medical history, current medications, initial lab work, initial and discharge National Institutes of Health Stroke Scale (NIHSS) scores, baseline modified Rankin Scale (mRS) score at discharge or earliest follow-up, imaging results, interventions, and overall mortality