Federico Di Maria1, Maéva Kyheng2, Arturo Consoli1, Jean-Philippe Desilles3, Benjamin Gory4,5, Sébastien Richard4,5, Georges Rodesch1, Julien Labreuche2, Jean-Baptiste Girot6, Cyril Dargazanli7, Gaultier Marnat8, Bertrand Lapergue9, Romain Bourcier10. 1. Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France. 2. University of Lille, CHU Lille, Lille, France. 3. Department of Interventional Neuroradiology, Fondation Ophtalmologique A. De Rothschild, Paris France. 4. Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France. 5. University of Lorraine, INSERM U1254, Nancy, France. 6. Department of Radiology, University Hospital of Angers, Angers, France. 7. Department of Neuroradiology, Guy de Chauliac University Hospital, Montpellier, France. 8. Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France. 9. Department of Neurology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France. 10. 0Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France.
Abstract
BACKGROUND: The first-pass effect, defined as a complete or near-complete recanalization after one pass (first-pass effect) of a mechanical thrombectomy device, has been related to better clinical outcome than good recanalization after more than one pass in acute ischemic stroke. We searched for predictors of first-pass effect by analyzing the results within a large prospective multicentric registry. METHODS: We included patients treated by mechanical thrombectomy for isolated anterior intracranial occlusions. A multi-variate logistic regression analysis was carried out to search for predictors of first-pass effect. We also analyzed the percentage of patients with 90-day modified Rankin Scale score 0 to 2, excellent outcome (90-day modified Rankin Scale 0 to 1), 24-h NIHSS change, and 90-day all-cause mortality. RESULTS: Among the 1832 patients included, clinical outcome at 90 days was significantly better in first-pass effect patients (50.6% vs. 38.9% in patients without first-pass effect), with a center-adjusted OR associated with first-pass effect of 1.74 (95%CI, 1.24 to 1.77). Older age, a lower systolic blood pressure, an MCA-M1 occlusion, higher DWI-ASPECTS at admission, mechanical thrombectomy under local anesthesia, and combined first-line device strategy were independent predictors of first-pass effect. CONCLUSIONS: In this study, a strategy combining thrombectomy and thrombo-aspiration was more effective than other strategies in achieving first-pass effect. In addition, we confirm that clinical outcome was better in patients with first-pass effect compared to non-first-pass effect patients.
BACKGROUND: The first-pass effect, defined as a complete or near-complete recanalization after one pass (first-pass effect) of a mechanical thrombectomy device, has been related to better clinical outcome than good recanalization after more than one pass in acute ischemic stroke. We searched for predictors of first-pass effect by analyzing the results within a large prospective multicentric registry. METHODS: We included patients treated by mechanical thrombectomy for isolated anterior intracranial occlusions. A multi-variate logistic regression analysis was carried out to search for predictors of first-pass effect. We also analyzed the percentage of patients with 90-day modified Rankin Scale score 0 to 2, excellent outcome (90-day modified Rankin Scale 0 to 1), 24-h NIHSS change, and 90-day all-cause mortality. RESULTS: Among the 1832 patients included, clinical outcome at 90 days was significantly better in first-pass effect patients (50.6% vs. 38.9% in patients without first-pass effect), with a center-adjusted OR associated with first-pass effect of 1.74 (95%CI, 1.24 to 1.77). Older age, a lower systolic blood pressure, an MCA-M1 occlusion, higher DWI-ASPECTS at admission, mechanical thrombectomy under local anesthesia, and combined first-line device strategy were independent predictors of first-pass effect. CONCLUSIONS: In this study, a strategy combining thrombectomy and thrombo-aspiration was more effective than other strategies in achieving first-pass effect. In addition, we confirm that clinical outcome was better in patients with first-pass effect compared to non-first-pass effect patients.
Authors: D A Schartz; N R Ellens; G S Kohli; S M K Akkipeddi; G P Colby; T Bhalla; T K Mattingly; M T Bender Journal: AJNR Am J Neuroradiol Date: 2022-03-17 Impact factor: 3.825
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