Abstract WP20: under the Influence: Exploring the Role of Cannabinoid Use in Ischemic Stroke

Background: Cannabinoids are hypothesized to cause cardiovascular disease including stroke; this is potentially due to dysregulation of endogenous lipid mediator endocannabinoids and their G-protein coupled receptors. Our aim is to investigate cannabinoid use in patients with acute ischemic stroke and determine associations between stroke subtype and functional outcome at 90-days. Methods: This is a retrospective, observational, cohort study of consecutive patients admitted with acute ischemic stroke to our Comprehensive Stroke Center. We included patients 60 years or younger who had a drug screen performed during their acute stroke hospitalization. We compared demographic factors, stroke subtype, and 90-day functional outcomes between the two groups (Cannabinoid positive vs. Cannabinoid negative). Stroke subtype was determined based on TOAST criteria, ESUS criteria and good outcome was defined as mRS 0-1 at 90-days. Results: We identified 256 patients who met inclusion criteria. Mean age was 50 years, 61% were men and 20% were cannabinoid positive. Cannabinoid positive patients were younger (47.0 ± 10.7 vs. 50.5 ± 8.5, p = 0.032) and more likely to test positive for cocaine (17.3% vs. 3.9%, p = 0.002). Gender and vascular risk factors including smoking were similar between cannabinoid positive and negative patients. Cannabinoid positive patients were more likely to have a stroke related to large artery atherosclerosis (23.0% vs. 10.3%, p = 0.020). In an adjusted binary regression analysis, cannabinoid use was associated with non-significantly lower odds of good outcome (OR 0.61 95% CI 0.31 -1.23, p = 0.1). Conclusions: Cannabinoid use is associated with atherosclerotic stroke subtypes and a non-significantly reduced likelihood of good functional recovery. Larger studies are needed to further test these associations.