Clinical impact of the first pass effect on clinical outcomes in patients with near or complete recanalization during mechanical thrombectomy for large vessel ischemic stroke

Memon, Muhammad Zeeshan; Daniel, David G.; Chaudhry, Mohammad Rauf A; Grewal, Manjot; Saini, Vasu; Lukas, Joshua; Siddu, Mithilesh; Algahtani, Rami; Nisar, Taha; Majidi, Shahram; Guerrero, Christopher R. Leon; Burger, Kathleen; Greenberg, Edward; Khandelwal, Priyank; Malik, Amer; Starke, Robert M.; Koch, Sebastian; Yavagal, Dileep R.

doi:10.1111/jon.12864

Cited by 5 publications

(5 citation statements)

References 41 publications

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“…Previous studies have shown that multi-passes and embolus escape seriously affect the MT efficiency ( 8 , 20 ). As a consequence, different adjunctive techniques, such as BGC, have been implemented to further decrease clot fragmentation and number of passes.…”

Section: Discussionmentioning

confidence: 99%

“…The successful recanalization rate through MT can be up to 90%, but the 90-day clinical favorable outcome is only about 50% ( 6 ). Several studies have reported that the first pass effect (FPE), which refers to achieving complete recanalization after one single pass without rescue therapy, is an important factor that affects the prognosis of patients ( 7 , 8 ). However, embolus escape during MT not only affects the FPE, but also increases the reperfusion time.…”

Section: Introductionmentioning

confidence: 99%

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Comparing the Conventional and Balloon-Guided Catheter-Assisted SWIM Technology for the Treatment of Acute Ischemic Stroke

Chen

Liu

et al. 2022

Front. Neurol.

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ObjectiveAcute ischemic stroke is common in elder patients. This study investigates whether using the balloon-guided catheter (BGC) would improve the effect of stent thrombectomy (Solitaire FR With Intracranial Support Catheter for Mechanical Thrombectomy, SWIM) for patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO).MethodThe data of 209 patients with AIS-LVO underwent SWIM were collected retrospectively from January 2017 to June 2021. These patients were divided into two groups based on whether they used of BGC or not. The propensity score matching (PSM) analysis was used to compare the differences in the first pass effect (FPE), successful recanalization, embolus escape rate, symptomatic intracranial hemorrhage (sICH), 90-day clinical favorable outcome, 90-day all-cause mortality, and complications in the patients treated with SWIM combined with balloon-guided catheter or conventional catheter.ResultsAmong the 209 patients, 44 patients were treated with BGC and 165 patients were not. After matching, a total of 111 patients were included. The results showed that there was no statistical difference in FPE (35.1% in non-BGC group compared to 24.3% in BGC group, matched RR, 0.59; 95% CI, 0.24–1.44), successful recanalization (89.2 vs. 91.9%, matched RR, 1.37; 95%CI, 0.34–5.51), embolus escape (6.8 vs. 8.1%, matched RR, 1.22; 95%CI, 0.28–5.40), sICH (8.1 vs. 13.5%; matched RR, 1.77; 95%CI 0.50–6.24), 90-day clinical favorable outcome (48.7 vs. 54.1%, matched RR, 1.11; 95%CI 0.51–2.46), 90-day all-cause mortality (17.6 vs. 21.6%, matched RR, 1.29; 95%CI 0.48–3.47), and the incidence of complications (6.8 vs. 5.4%, matched RR, 0.79 95%CI 0.15–4.27). These results indicate that using SWIM as the first-line treatment for patients with AIS-LVO, there is no statistical significance in FPE, final successful recanalization, distal emboli, sICH, procedural time, 90-day favorable outcome, 90-day mortality, and complications with or without BGC.ConclusionBalloon-guided catheter does not affect the result of using SWIM as the first-line treatment for patients with AIS-LVO. Our results will guide daily practice, with the adoption of the use of a guided catheter without a balloon.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing the Conventional and Balloon-Guided Catheter-Assisted SWIM Technology for the Treatment of Acute Ischemic Stroke

Chen

Liu

et al. 2022

Front. Neurol.

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“…It has been proposed that multiple passes of thrombectomy devices are associated with a higher risk for distal embolization and vessel injury ( 20 ). Several reports proved that first-pass reperfusion was associated with a more favorable clinical outcome than multiple passes, irrespective of different thrombectomy techniques ( 21 – 23 ). Therefore, more thrombectomy maneuvers may be one of the causes of worse outcomes in the rescue SR group.…”

Section: Discussionmentioning

confidence: 99%

Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them?

Cheng

Chen

et al. 2021

Front. Neurol.

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Introduction: Recent trials have demonstrated the superior efficacy of mechanical thrombectomy over other medical treatments for acute ischemic stroke; however, not every large vessel occlusion (LVO) can be recanalized using a single thrombectomy device. Rescue devices were proved to increase the reperfusion rate, but the efficacy is unclear.Objective: In this retrospective study, we evaluated the efficacy of rescue therapy in different locations of LVO.Methods: We analyzed the outcomes of mechanical thrombectomy from a prospective registry of consecutive 82 patients in Taipei Medical University Hospital. The reperfusion rate and the functional outcome were compared in patients who received first-line therapy only and patients who need rescue therapy.Results: An 84.1% reperfusion rate was achieved in our cohort. We applied first-line stent retriever (SR) treatment in 6 patients, among which 4 (66.6%) achieved successful reperfusion. We applied a direct-aspiration first-pass technique (ADAPT) as the first-line treatment in 76 patients, among which 46 (60.5%) achieved successful reperfusion. Successful reperfusion could not be achieved in 30 cases (39.5%); therefore, we applied a second-line rescue SR for 28 patients, and reperfusion was established in 18 (64.3%) of them. These results revealed that the LVO in anterior circulation has a higher chance to respond to SR rescue therapy than posterior circulation lesions (68 vs. 33.3%, P < 0.001). Patients who received only first-line therapy exhibited significantly better functional outcomes than those who were also treated with rescue SR therapy (41.2 vs. 16.7%, P = 0.001). In addition, patients with LVO in the anterior circulation were found to have a higher probability of achieving functional independence than patients with posterior circulation lesions (10.7 vs. 0.0%, P < 0.001). The adjusted multivariate analysis revealed that successful reperfusion and treatment type (first-line or rescue therapy) were significantly related to a modified Rankin Scale (mRS) score at 90 days.Conclusion: This study reveals that rescue SR therapy improves the reperfusion rate. Patients who require rescue SR therapy have a lower likelihood of functional independence. LVO in the anterior circulation responds better to rescue SR therapy and results in better functional outcomes than posterior circulation lesions.

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“…Single-pass or first-pass recanalization has been proposed as a strategy to reduce the time required to achieve successful recanalization [ 11 ]. Finally, beyond the classical endpoint of endovascular treatment (mTICI grade 2b or 3, as early as possible), a new concept (mTICI grade 2c or 3 by the first pass of the device) has recently been highlighted for the best endovascular performance [ 11 12 13 14 15 16 17 18 ]. The conceptual relevance of the first-pass achievement of mTICI grade 2c or 3 has been demonstrated in several clinical studies.…”

Section: Introductionmentioning

confidence: 99%

“…The conceptual relevance of the first-pass achievement of mTICI grade 2c or 3 has been demonstrated in several clinical studies. Briefly, first-pass recanalization to mTICI grade 2c or 3 was significantly associated with superior clinical outcomes [ 6 11 12 13 14 15 16 17 18 19 ].…”

Section: Introductionmentioning

confidence: 99%

First-Pass Recanalization with EmboTrap II in Acute Ischemic Stroke (FREE-AIS): A Multicenter Prospective Study

et al. 2023

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Objective We aimed to evaluate the efficacy of EmboTrap II in terms of first-pass recanalization and to determine whether it could yield favorable outcomes. Materials and Methods In this multicenter, prospective study, we consecutively enrolled patients who underwent mechanical thrombectomy using EmboTrap II as a front-line device. The primary outcome was the first pass effect (FPE) rate defined by modified Thrombolysis In Cerebral Infarction (mTICI) grade 2c or 3 by the first pass of EmboTrap II. In addition, modified FPE (mFPE; mTICI grade 2b–3 by the first pass of EmboTrap II), successful recanalization (final mTICI grade 2b–3), and clinical outcomes were assessed. We also analyzed the effect of FPE on a modified Rankin Scale (mRS) score of 0–2 at 3 months. Results Two hundred-ten patients (mean age ± standard deviation, 73.3 ± 11.4 years; male, 55.7%) were included. Ninety-nine patients (47.1%) had FPE, and mFPE was achieved in 150 (71.4%) patients. Successful recanalization was achieved in 191 (91.0%) patients. Among them, 164 (85.9%) patients underwent successful recanalization by exclusively using EmboTrap II. The time from groin puncture to FPE was 25.0 minutes (interquartile range, 17.0–35.0 minutes). Procedure-related complications were observed in seven (3.3%) patients. Symptomatic intracranial hemorrhage developed in 14 (6.7%) patients. One hundred twenty-three (58.9% of 209 completely followed) patients had an mRS score of 0–2. Sixteen (7.7% of 209) patients died during the follow-up period. Patients who had successful recanalization with FPE were four times more likely to have an mRS score of 0–2 than those who had successful recanalization without FPE (adjusted odds ratio, 4.13; 95% confidence interval, 1.59–10.8; p = 0.004). Conclusion Mechanical thrombectomy using the front-line EmboTrap II is effective and safe. In particular, FPE rates were high. Achieving FPE was important for an mRS score of 0–2, even in patients with successful recanalization.

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Clinical impact of the first pass effect on clinical outcomes in patients with near or complete recanalization during mechanical thrombectomy for large vessel ischemic stroke

Cited by 5 publications

References 41 publications

Comparing the Conventional and Balloon-Guided Catheter-Assisted SWIM Technology for the Treatment of Acute Ischemic Stroke

Comparing the Conventional and Balloon-Guided Catheter-Assisted SWIM Technology for the Treatment of Acute Ischemic Stroke

Added Value of Rescue Devices in Intra-Arterial Thrombectomy: When Should We Apply Them?

First-Pass Recanalization with EmboTrap II in Acute Ischemic Stroke (FREE-AIS): A Multicenter Prospective Study

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