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Research Article | DOI: https://doi.org/10.31579/2692-9406/238
1School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
2Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan.
3Department of Science in Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
4Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung, Taiwan.
*Corresponding Author: Hao-Kuang Wang, Department of Neurosurgery, E-Da Hospital/ I-Shou University, Kaohsiung, Taiwan No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan.
Citation: Tzu-Ning Chen, Jyun-Yuan Huang, Te-Yuan Chen, Yu-Ying Wu, Po-Yuan Chen, et al., (2025). Smoking–Thrombectomy Paradox: A Prospective Single- Center Study on the Impact of Smoking Status on Reperfusion Rates., J, Biomedical Research and Clinical Reviews, 11(3) DOI: 10.31579/2692-9406/238.
Copyright: © 2025 Hao-Kuang Wang. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 12 December 2025 | Accepted: 22 December 2025 | Published: 30 December 2025
Keywords: endovascular thrombectomy; smoking; reperfusion; neurological outcomes
Background: Smoking is a well-established risk factor for acute ischemic stroke, but its influence on endovascular thrombectomy outcomes remains unclear. While previous studies suggested a “smoking paradox” in thrombolysis, evidence regarding EVT is limited.
Methods: We conducted a prospective, single-center observational study of 169 patients with acute ischemic stroke who underwent EVT between January 2019 and March 2023, using data from a tertiary hospital thrombectomy database in Kaohsiung, Taiwan. Patients were categorized as smokers (n=52) or non-smokers (n=117). Baseline characteristics were adjusted using inverse probability of treatment weighting. The primary endpoint was complete reperfusion. Secondary outcomes included NIHSS scores
Results: Smokers were younger and more often male, with lower rates of atrial fibrillation. After IPTW adjustment, smokers had significantly lower rates of complete reperfusion compared to non-smokers (30% vs. 53%; OR 0.39; 95% CI 0.19–0.79; p=0.01). They also presented with higher NIHSS scores at admission and 24 hours post-thrombectomy (p<0.05), and an increased risk of stroke-associated pneumonia (OR 2.98; p=0.003). No significant difference in discharge mRS was observed.
Conclusions: Smoking is associated with reduced reperfusion success, worse neurological status, and higher pneumonia risk after EVT, but not with short-term functional outcome. These findings contradict the notion of a smoking–reperfusion paradox in EVT-treated AIS patients.
Acute ischemic stroke (AIS) is a leading cause of death and long-term disability worldwide. Endovascular thrombectomy (EVT) has become the standard treatment for large vessel occlusion, providing high rates of reperfusion and improved clinical outcomes. Smoking is a well-established risk factor for AIS, yet its impact on reperfusion therapies remains controversial. Previous studies have described the so- called “smoking paradox,” in which smokers appeared to achieve higher recanalization rates and better outcomes following intravenous thrombolysis [1,2].
However, there is little study mentioning the evidence regarding the effect of smoking on EVT outcomes. The TREAT-AIS [3] study is a large multicenter, prospective, observational registry conducted in Taiwan, involving 10 medical centers and 9 community hospitals, including our institution. This nationwide collaboration enrolled patients aged 20 years or older who underwent EVT for acute ischemic stroke and collected detailed clinical information such as vascular risk factors, laboratory findings, periprocedural complications, neurological assessments, and functional outcomes. Given the richness of this dataset, it provides a unique opportunity to explore clinically relevant questions. In the present study, we analyzed data from our hospital and focused on the relationship between cigarette smoking and EVT outcomes, aiming to clarify whether smoking status influences reperfusion success and clinical recovery after stroke.
Study Design and Population
This is a prospective, single-centered, observational cohort study conducted at the Center for Stroke Research at Eda hospital. Acute stroke patients who received thrombectomy between January 2019 and March 2023 were enrolled in this study. The inclusion criteria were as follows (1) adult patients (2) thrombectomy performed after acute ischemic stroke. Patients with incomplete data were excluded.
All patients had provided informed consent for medical treatment prior to their inclusion in our hospital’s thrombectomy database, in which all data were anonymized. Because the present study utilized only anonymized data from this database, the requirement for additional informed consent was waived. The study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of Eda Hospital.
Clinical Data Collection
An electronic data registration sheet was used for this study. The data sheet included the following variables: age, sex, body mass index (BMI), comorbidities (including hypertension, diabetes mellitus, dyslipidemia, cerebrovascular accident, transient ischemic attack, and atrial fibrillation), smoking history, alcohol consumption history, target vessels, National Institutes of Health Stroke Scale (NIHSS) score at admission and at 24 hours post-thrombectomy, modified Rankin Scale (mRS) score at discharge, and complications.
Clinical Assessment and Procedures
On admission, each patient was systematically evaluated for cerebrovascular risk factors, including smoking, arterial hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, chronic kidney disease (CKD), history of transient ischemic attack (TIA), and alcohol consumption. Patients who reported active cigarette use were classified as smokers, whereas those who had quit smoking for more than six months were considered non-smokers.
For patients presenting with stroke-related symptoms, such as headache, hemiplegia, facial drooping, or speech difficulties, diagnostic imaging with brain computed tomography angiography (CTA) and computed tomography reperfusion (CTP), or brain magnetic resonance imaging (MRI), was performed to confirm the diagnosis of acute ischemic stroke. Eligibility for EVT was determined according to the current recommendations of the American Heart Association/American Stroke Association and the Taiwan Stroke Society guidelines.
Outcomes
The primary endpoint was successful complete reperfusion, defined as a Thrombolysis in Cerebral Infarction (TICI) grade 3. Secondary endpoints included the NIHSS score at admission and 24 hours after thrombectomy, the mRS score at discharge, and the occurrence of complications such as pneumonia, urinary tract infection (UTI), sepsis, acute coronary syndrome (ACS), and seizure. NIHSS was treated as a continuous covariate in the regression analyses. The mRS was dichotomized into favorable (0~2) and unfavorable (3~6) outcomes.
Statistical Analysis
Group comparisons were performed using the chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. To address potential selection bias, we applied inverse probability of treatment weighting (IPTW) to control for differences in baseline characteristics between smokers and non- smokers. Propensity scores were estimated using logistic regression models based on age and sex. Each individual in the smoking group was weighted by 1/propensity score, and those in the non-smoking group were weighted by 1/ (1 − propensity score). Covariate balance after weighting was assessed using standardized differences and visualized with Love plots.
Logistic regression and descriptive analyses were conducted to assess the association between smoking status and successful complete reperfusion. NIHSS scores at hospitalization and 24 hours post-procedure were treated as continuous variables and analyzed using univariate and multivariate linear regression. The mRS at discharge was dichotomized and evaluated with logistic regression. Complications were compared using the chi-square test. Two-tailed p values were reported, with statistical significance defined as p ≤ 0.05. All statistical analyses were performed with SPSS Statistics for Windows, version 31.0 (IBM Corp., Armonk, NY, USA).
Patient Characteristics
A flowchart of participant selection is presented in (Figure 1). A total of 184 patients who underwent mechanical thrombectomy for acute ischemic stroke were initially enrolled. After excluding patients with incomplete data, 169 patients were included in the final analysis. Among these, 52 (30.8%) were classified as the smoking group, and 117 (69.2%) as the non-smoking group. Baseline characteristics of the two groups are summarized in (Table 1).
Compared with the non-smoking group, the smoking group was significantly younger (mean age, 59.46 vs. 73.96 years; p less than 0.001), had a higher proportion of male patients (84.6% vs. 35.9%; p less than 0.001), more alcohol use (50.0% vs. 4.3%; p less than 0.001), and a lower prevalence of hypertension (53.8% vs. 77.8%; p = 0.002). Atrial fibrillation was less common in the smoking group (25.0% vs. 47.9%; p = 0.005).
There were no significant differences between groups in body mass index (BMI), diabetes mellitus, dyslipidemia, history of cerebrovascular accident (CVA), or transient ischemic attack (TIA). Additionally, there was no significant difference in the distribution of target vessels between the anterior and posterior circulations.
To address baseline differences between the two groups, inverse probability of treatment weighting (IPTW) was applied using age and sex, both considered clinically relevant covariates. After IPTW adjustment, the standardized mean difference (SMD) for age was 0.025, and the SMD for sex was 0.14—slightly above the conventional threshold of 0.1 but substantially improved compared to the pre- IPTW value (Figure 2). All subsequent analyses were performed using IPTW- adjusted data.
Primary Endpoint
Patients who achieved grade 3 on the TICI scale were considered to have reached the primary endpoint. Compared with the non-smoking group, patients in the smoking group had a significantly lower rate of complete reperfusion (30% vs. 53%; OR, 0.39; 95% CI, 0.19–0.79; p = 0.01) (Table 2, Figure 3).
Secondary Endpoint
For secondary endpoints, the association between smoking and clinical outcomes was further examined. Smokers had significantly higher NIHSS scores at admission (mean difference 2.98; 95% CI 0.67–5.23; p= 0.012) and at 24 hours after thrombectomy (mean difference 4.77; 95% CI 1.29–8.25; p= 0.007) compared with non-smokers. Multivariate regression confirmed these findings, showing consistently higher NIHSS scores in smokers at both hospitalization (p= 0.011) and 24 hours post-procedure (p= 0.005). The mRS at discharge was analyzed as an ordinal variable and further dichotomized into favorable (0–2) and unfavorable (3–6) outcomes. Logistic regression analysis demonstrated no significant association between two groups.
Complications were compared between groups using the chi-square test. Smokers had a significantly higher incidence of pneumonia compared with non-smokers (OR 2.98, 95% CI 1.43~5.85, p=0.003), whereas other complications, including sepsis, urinary tract infection, acute coronary syndrome, and seizure, were not significantly associated with smoking status.
Figure 1: Study Flowchart: A total of 184 patients who underwent mechanical thrombectomy for acute ischemic stroke were initially enrolled. After excluding patients with incomplete data, 169 patients were included in the final analysis. Among these, 52 (30.8%) were classified as the smoking group, and 117 (69.2%) as the non-smoking group.
Figure2: Love plot of Covariate balance: After IPTW adjustment, the SMD for age was 0.025, and the SMD for sex was 0.14—slightly above the conventional threshold of 0.1 but substantially improved compared to the pre-IPTW value.
Figure 3: Bar Chart of Success Rate of Complete Reperfusion between Smoking and Non-smoking Groups.
Figure 4: Complications
| Variable | Before IPTW Adjustion | After IPTW Adjustion | ||||
Smoker (n=52) | Non-smoker (n=117) | p- value* | Smoker | Non- smoker | p- value* | |
| Age (years) | 59.46 ± 1.9 | 73.96 ± 2.03 | <0> | 68.29 ± | 68.65 ± | 0.707 |
| 2.07 | 1.3 | |||||
| BMI (kg/m²) | 24.92 ± | 24.47 ± 3.37 | 0.334 | 25.15 ± | 25.41 ± | 0.745 |
| 0.54 | 0.49 | 0.43 | ||||
| Sex male | 44 (84.6%) | 42 (35.9%) | <0> | 60% | 53% | 0.409 |
| Hypertension | 28 (53.8%) | 91 (77.8%) | 0.002 | 72% | 69% | 0.694 |
| Diabetes mellitus | 15 (28.8%) | 45 (38.5%) | 0.228 | 28% | 33% | 0.598 |
| Dyslipidemia | 15 (28.8%) | 38 (32.5%) | 0.639 | 24% | 30% | 0.436 |
| CVA | 6 (11.5%) | 24 (20.5%) | 0.286 | 13% | 18% | 0.415 |
| TIA | 0 (0%) | 2 (1.7%) | 0.638 | 0% | 0.8% | 0.68 |
| Atrial fibrillation | 13 (25.0%) | 56 (47.9%) | 0.005 | 22% | 41% | 0.021 |
| Alcohol use | 26 (50.0%) | 5 (4.3%) | <0> | 43% | 6% | <0> |
| Target Vessel (Anterior Circulation) | 47 (90%) | 101 (86%) | 0.46 | 94% | 86% | 0.178 |
Table 1: Baseline Characteristics of Patients
Data before weighting are presented as number (%) or mean ± SD. Post-IPTW adjustment cohort data are presented as mean ± SD or %. The total numbers of participants in the IPTW columns were omitted as the patient numbers were altered because of weighting.
* Determined with the Pearson’s chi-square test and Mann-Whitney U test.
| Success Rate | Odds ratio (95%Cl) | p value | ||
| Non-smokers | smokers | |||
| Complete Perfusion | 0.53 | 0.3 | 0.39 (0.19–0.79) | 0.01 |
Table 2: Success Rate of Complete Reperfusion based on smoking status
| Univariate Analysis | Multivariate Analysis ‡ | |||
OR/ β coefficient (95% Cl) | p value | β coefficient (95% Cl) | p value | |
| NIHSS_Hospitalization | -2.95 (-5.23, -0.67) * | 0.012 | -2.98 (-5.27~-0.68) | 0.011 |
| NIHSS_24hr | -4.77 (-8.25, -1.29) * | 0.007 | -4.93 (-8.37~-1.49) | 0.005 |
| mRS_Discharge | 0.34 (0.52~3.81) † | 0.5 | - | - |
Table 3: Response of Clinical Outcomes to thrombectomy based on smoking status
NIHSS was treated as continuous variables and analyzed with univariate and multivariate regression. The mRS at discharge was dichotomized into favorable (0–2) and unfavorable (3–6) outcomes and analyzed with logistic regression model.
*β coefficient; † odds ratio
| Incidence | RR (95%Cl) | Odds ratio (95%Cl) | p value | ||
| Non-Smokers | Smokers | ||||
| All | 0.57 | 0.66 | 1.11 (0.92~1.34) | 1.48 (0.73~2.99) | 0.272 |
| Pneumonia | 0.29 | 0.54 | 1.36 (1.09~1.74) | 2.89 (1.43~5.83) | 0.003 |
| Sepsis | 0.06 | 0.02 | 0.82 (0.62~1.08) | 0.36 (0.43~2.99) | 0.324 |
| UTI | 0.22 | 0.35 | 1.23 (0.98~1.98) | 1.93 (0.91~4.07) | 0.082 |
| ACS | 0.02 | 0.01 | 0.72 (0.65~0.79) | 0.36 (0.01~10.93) | 0.279 |
| Seizure | 0.05 | 0.04 | 0.96 (0.64~1.45) | 0.86 (0.17~4.44) | 0.861 |
Table 4: Complications
In this prospective, single-center study of 169 patients with acute ischemic stroke, the primary endpoint of complete reperfusion was achieved in 53% of non-smokers compared with 30% of smokers. Smokers had significantly lower odds of achieving complete reperfusion (OR, 0.39; 95% CI, 0.19–0.79; p = 0.01). Clinical outcomes were further evaluated using two scales. Compared with non-smokers, smokers had significantly higher NIHSS scores at admission (β = –2.95; 95% CI, –5.23 to –0.67; p = 0.012) and at 24 hours after thrombectomy (β = –4.77; 95% CI, –8.25 to –1.29; p = 0.007). No significant difference in functional outcome was observed when assessed by the mRS at discharge (OR, 0.34; 95% CI, 0.52~3.81; p = 0.5).
To our knowledge, this is the first study to investigate the association between smoking and outcomes of EVT in patients with acute ischemic stroke. The so-called smoking–reperfusion paradox has been a matter of debate for a long time. Kufner et al.2 reported that smoking was independently associated with enhanced tPA efficacy and higher rates of recanalization and reperfusion. Kurmann et al. [1] found smoking to be significantly associated with higher recanalization rates in patients with M1 occlusion treated with intravenous thrombolysis. In contrast, our cohort demonstrated that smoking was significantly associated with lower rates of recanalization following EVT. This discrepancy may be explained by differences in thrombus composition and vascular pathology [4]. Compared with non-smokers, thrombi from smokers are richer in fibrinogen and platelets and more responsive to rt-PA, which binds to fibrin and facilitates clot lysis [4]. Chronic smoking also promotes vascular remodeling, endothelial dysfunction, and increased arterial stiffness [4,5].
Moreover, smoking has been reported to reduce cerebral blood flow and increase blood viscosity [6]. Collectively, these factors may create a less favorable endovascular environment, complicating EVT by hindering device navigation and increasing the difficulty of thrombus retrieval.
Xu et al [7]. reported that smoking was not associated with favorable 90-day outcomes following intravenous thrombolysis. Similarly, Zhang et al. [8] identified smoking as a risk factor for poor 3-month outcomes in patients with severe AIS, and Matsuo et al. [9] found current smoking to be associated with an increased risk of unfavorable functional outcomes at 3 months after acute ischemic stroke. In our study, after adjusting for confounders, non-smokers demonstrated significantly better neurological function, as reflected by lower NIHSS scores at admission (mean difference, 2.98 points; 95% CI, 0.67–5.23; p = 0.012) and at 24 hours after thrombectomy (mean difference, 4.77 points; 95% CI, 1.29–8.25; p = 0.007). These findings suggest that smoking has a detrimental effect on baseline and early post- thrombectomy neurological status. However, no significant difference was observed between groups with respect to functional outcomes at discharge as measured by the mRS. This discrepancy may be explained by the limited 7-point range of the mRS (0–6) compared with the broader 43-point range of the NIHSS (0–42). Notably, a previous study demonstrated that 24-hour NIHSS is a reliable surrogate for 90-day mRS in patients with AIS undergoing EVT [10].
As expected, smoking was associated with younger age, male sex, lower prevalence of atrial fibrillation, and higher alcohol consumption. After IPTW adjustment, non- smokers continued to show a significantly higher rate of atrial fibrillation, which may partly explain their increased risk of AIS. In our cohort, the mean age at stroke onset was 59.5 years in smokers and 73.9 years in non-smokers. These findings are consistent with a previous study reporting mean onset ages of 60.2 years for current smokers and 71.6 years for non-smokers [11]. The age difference between the two groups in our study was approximately 14 years, indicating that smokers experience stroke, along with its associated increasing neurological deficits and disability, more than a decade earlier than non-smokers. The overall smoking rate in this study is around 30%, relatively higher than the adult smoking rate in Taiwan, which is around 14% in 2022. This may be attributable to the hospital’s location in an industrial area.
Stroke-associated pneumonia (SAP) is one of the most frequent and serious complications following stroke. In our study, the incidence of SAP was 36%, which is higher than the 13–23% reported in previous studies [12-14]. This discrepancy may in part be attributable to the higher prevalence of smoking in our cohort. Our study also demonstrated that smokers had a higher risk of developing SAP. SAP is primarily related to aspiration, as patients with AIS often experience neurological deficits such as impaired swallowing and a weakened cough reflex. In addition, the cholinergic pathway has been implicated in the pathophysiology of SAP. Experimental studies demonstrated rapidly stimulated parasympathetic activity after stroke in mice, leading to impaired alveolar immune responses and increased susceptibility to pneumonia [15]. Patients who develop SAP typically have worse prognoses, including higher mortality and poorer long-term outcomes [12,13]. Prophylactic antibiotic therapy is not recommended, as it has been shown to have no impact on SAP incidence, underscoring the importance of prevention strategies focused on attenuated cough function and dysphagia after stroke [14].
This study has some limitations. First, the relatively small sample size may introduce selection bias and limit statistical power, increasing the risk of type II errors. Secondly, although IPTW was applied to adjust for baseline confounders including age and sex, the SMD for sex after weighting remained 0.14, indicating residual imbalance. Due to limited sample size, we could only include the age and sex in the propensity score model. Consequently, we cannot entirely rule out the potential influence of other unmeasured confounding variables. As a result, the results should be interpreted with caution. There was a lack of quantitative data including how many cigarettes in one day and how long the smoking history persisted. Additional analyses of trials that include larger size of data with more detailed information of smoking behavior would be excellent to explore this topic further.
Our study demonstrated that smoking is an unfavorable predictor of complete reperfusion after thrombectomy in patients with acute ischemic stroke. Smoking is also associated with worse neurological status and a higher risk of stroke-associated pneumonia, although it does not significantly affect functional outcomes at discharge. In conclusion, our findings do not support the existence of a smoking–reperfusion paradox in patients treated with thrombectomy.
Funding
This study did not receive any funding or other financial support.
Disclosure
The authors declare that they have no competing interests.
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Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
