Cannabis-related peripheral arteriopathy, coronary disease and stroke

The implication of cannabis use in several vascular complications is still debated, as their incidence remains low in comparison with the broad exposure to cannabis in the general population. The three main systems that could be involved are the brain, with stroke as the main disorder, the heart, with acute coronary syndrome (ACS) and arrhythmias, and the peripheral vasculature, with thromboangiitis obliterans (TAO). All the available epidemiological data support an association between cannabis use and the risk for ACS or stroke. Usually, there is a close temporal relationship between cannabis exposure and the occurrence of ACS or stroke. In most of the patients, other potential causes could also be reasonably excluded through a detailed work-up. There is also a significant incidence of relapse after re-exposure. However, this type of association does not formally demonstrate a causal link. In the majority of the studies, cannabis use could not be considered as an independent risk factor due to the concurrent exposure to tobacco. The most commonly accepted mechanism for developing stroke or ACS is the development of a transient vasospasm, as recently described in patients presenting reversible cerebral vasoconstriction syndrome. Concerning peripheral arteriopathy, cannabis arteritis is sharing several epidemiological, clinical and radiological features with TAO (Buerger's disease). The link between TAO and nicotine smoking is well established. We can probably consider cannabis use as another triggering factor. The clinical course of cannabis arteritis is influenced by cannabis withdrawal or re-exposure. (C) 2016 Societe Francaise de Toxicologie Analytique. Published by Elsevier Masson SAS. All rights reserved.