First Pass Effect With Neurothrombectomy for Acute Ischemic Stroke: Analysis of the Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke Registry

Abstract

Background and Purpose: Achieving complete revascularization after a single pass of a mechanical thrombectomy device (first pass effect [FPE]) is associated with good clinical outcomes in patients with acute ischemic stroke due to large vessel occlusion. We assessed patient characteristics, outcomes, and predictors of FPE among a large real-world cohort of patients (Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic Stroke registry). Methods: Demographics, clinical outcomes, and procedural characteristics were analyzed among patients in whom FPE (modified Thrombolysis in Cerebral Infarction 2c/3 after first pass) was achieved versus those requiring multiple passes (MP). Modified FPE and modified MP included patients achieving modified Thrombolysis in Cerebral Infarction 2B-3. Primary outcomes included 90-day modified Rankin Scale (mRS) score and mortality. Results: Among 984 Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic Stroke patients, 930 had complete 90-day follow-up. FPE was achieved in 40.5% (377/930) of patients and MP in 20.0% (186/930). Baseline characteristics were similar across all groups. The FPE group had fewer internal carotid artery occlusions compared with MP ( P =0.029). The FPE group had faster puncture to recanalization time ( P ≤0.001), higher rates of 90-day mRS score of 0 to 1 (52.6% versus 38.6%, P =0.003), mRS score of 0 to 2 (65.4% versus 52.0%, P =0.003), and lower 90-day mortality compared with the MP group (12.0% versus 18.7%, P =0.038). Similarly, compared with modified MP patients, the modified FPE group had fewer internal carotid artery occlusions ( P =0.004), faster puncture to recanalization time ( P ≤0.001), and higher rates of 90-day mRS score of 0 to 1 ( P =0.002) and mRS score of 0 to 2 ( P =0.003). Conclusions: Our findings demonstrate that FPE and modified FPE are associated with superior clinical outcomes.