Effects of first pass recanalization on outcomes of contact aspiration thrombectomy

Abstract

BackgroundFirst pass recanalization (FPR, defined as achieving a modified Thrombolysis in Cerebral Ischemia (mTICI) grade 2c/3 with a single pass of a thrombectomy device) effect has not yet been evaluated in contact aspiration thrombectomy (CAT). We evaluated FPR effect on clinical outcomes and FPR predictors in CAT.MethodsAll consecutive patients who underwent frontline CAT for anterior circulation large vessel occlusion with recanalization (mTICI 2b–3) were identified from registries at six stroke centers. The patients were dichotomized into FPR and non-FPR groups. Clinical features and outcomes were compared between the groups. Multivariate analyses were performed to determine whether FPR was independently associated with clinical outcomes and to identify predictors of FPR.ResultsOf the 429 patients who underwent frontline CAT, recanalization was successful in 344 patients (80.2%; mean age 68.7±11.0 years; M:F ratio 179:165). The FPR group had a higher rate of good outcome (modified Rankin Scale score 0–2) than the non-FPR group. Furthermore, the good outcome rate was higher in the FPR group than in patients who achieved mTICI 2c/3 with multiple passes or rescue treatment. FPR (OR 2.587; 95% CI 1.237 to 5.413) remained independently associated with good outcomes, in addition to age, baseline National Institute Health Stroke Scale, and coronary artery disease. The use of a balloon guide catheter (OR 3.071; 95% CI 1.699 to 5.550) was the only predictor of FPR.ConclusionsPatients in the FPR group had better clinical outcomes than the non-FPR group in CAT. FPR was independently associated with a good outcome. The use of a balloon guide catheter was the only predictor of FPR.

Clinical and Non-Clinical Determinants of the Effect of Mechanical Thrombectomy and Post-Stroke Functional Status of Patients in Short and Long-Term Follow-Up

“…It appears that efficacious time management (door-to-puncture and puncture-to-reperfusion) increases the efficacy of the procedure. Recanalization after the first passage has been shown to increase the success of MT, also by the other authors [52][53][54][55]. Identifying the factors which influence the first-pass effect may help to optimally select the patients for MT based on pre-interventional risk factors and their possible modification options.…”

Factors Influencing Recanalization After Mechanical Thrombectomy With First-Pass Effect for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

“…Among those, age, female gender, general anesthesia, use of BGC, and occlusion of ICA also increased the chance of complete reperfusion after first-pass thrombectomy. BGC use has been widely accepted contributing to FPE during thrombectomy procedure (7,9,13,15). One of the reasons may be decreased distal embolization and more importantly increased flow reversal.…”

“…However, some trials showed that functional independence in AIS patients is only around 50% even with a high recanalization rate of over 70% (3,6). Thrombectomy with first pass effect (FPE), an emerging new metric, is strongly correlated with improved functional outcomes (7)(8)(9)(10). Thrombectomy with FPE may have many advantages such as less vessel wall injury, lower risk of clot fragments, and decreased time to reperfusion (8,11).…”

Nomogram to Predict the Number of Thrombectomy Device Passes for Acute Ischemic Stroke with Endovascular Thrombectomy

“…9 Previously, numerous studies focused on the number of thrombectomy device passes during intravascular treatment procedures and reported that the number of thrombectomy device passes is closely related to the clinical outcome and prognosis of patients with ischemic stroke. [9][10][11][12][13][14] The most significant predictor of good prognosis was successful target-vessel recanalization. 11,15 With every additional thrombectomy device pass, the vascular recanalization rate for each individual receiving continuous thrombectomy decreases successively.…”