First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial

Ducroux, Célina; Piotin, Michel; Gory, Benjamin; Labreuche, Julien; Blanc, Raphaël; Maacha, Malek Ben; Lapergue, Bertrand; Fahed, Robert

doi:10.1136/neurintsurg-2019-015215

Cited by 90 publications

(78 citation statements)

References 33 publications

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“…26 Additionally, the association between FPE and favorable clinical outcome (mRS score at 90 days of 0-2 or equal to pre-stroke mRS score) has been shown to be independent of the technique used (stent retriever vs aspiration, p=0.29). 27 This analysis demonstrated that achieving mTICI 2c-3 after the first pass was associated with reduced healthcare resource use. Patients in the FPE group required fewer thrombectomy devices; the number of devices used to achieve mTICI 2c-3 is inevitably linked to the number of passes even though up to three attempts with the same device were allowed in the EmboTrap instructions for use.…”

Section: Discussionmentioning

confidence: 83%

Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective

Zaidat

Ribó

Mattle

et al. 2020

J NeuroIntervent Surg

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BackgroundFirst-pass effect (FPE), restoring complete or near complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) in a single pass, is an independent predictor for good functional outcomes in the endovascular treatment of acute ischemic stroke. The economic implications of achieving FPE have not been assessed.ObjectiveTo assess the economic impact of achieving complete or near complete reperfusion after the first pass.MethodsPost hoc analyses were conducted using ARISE II study data. The target population consisted of patients in whom mTICI 2c–3 was achieved, stratified into two groups: (1) mTICI 2c–3 achieved after the first pass (FPE group) or (2) after multiple passes (non-FPE group). Baseline characteristics, clinical outcomes, and healthcare resource use were compared between groups. Costs from peer-reviewed literature were applied to assess cost consequences from the perspectives of the United States (USA), France, Germany, Italy, Spain, Sweden, and United Kingdom (UK).ResultsAmong patients who achieved mTICI 2c–3 (n=172), FPE was achieved in 53% (n=91). A higher proportion of patients in the FPE group reached good functional outcomes (90-day modified Rankin Scale score 0–2 80.46% vs 61.04%, p<0.01). The patients in the FPE group had a shorter mean length of stay (6.10 vs 9.48 days, p<0.01) and required only a single stent retriever, whereas 35% of patients in the non-FPE group required at least one additional device. Driven by improvement in clinical outcomes, the FPE group had lower procedural/hospitalization-related (24–33% reduction) and annual care (11–27% reduction) costs across all countries.ConclusionsFPE resulted in improved clinical outcomes, translating into lower healthcare resource use and lower estimated costs.

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Section: Discussionmentioning

confidence: 83%

Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective

Zaidat

Ribó

Mattle

et al. 2020

J NeuroIntervent Surg

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“…The definition of a successful procedure in stroke endovascular therapy is continuously shifting toward more complete and faster recanalization [6,[26][27][28] and eTICI 3 at FP represents the ultimate goal. The rate of successful recanalization at FP is present in~28% of patients treated with mechanical thrombectomy [6,29]. This low rate underlines the need to develop strategy and devices that can successfully retrieve thrombi in fewer passes.…”

Section: Discussionmentioning

confidence: 99%

Benefit of first‐pass complete reperfusion in thrombectomy is mediated by limited infarct growth

Hassen

Tordjman

Boulouis

et al. 2020

Euro J of Neurology

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Background and Purpose: The number of clot retrieval attempts required to achieve complete reperfusion by mechanical thrombectomy impacts functional outcome in acute ischaemic stroke (AIS). Complete reperfusion [expanded Treatment In Cerebral Infarction (eTICI) score = 3] at first pass (FP), is associated with the highest rates of favorable outcome compared to complete reperfusion by multiple passes. The aim of the present study was to investigate the relationship between FP complete reperfusion and infarct growth (IG). Methods: Anterior AIS patients with baseline and 24-h diffusion-weighted magnetic resonance imaging were included from two prospective registries. IG was measured by voxel-based segmentation of initial and 24-h diffusionweighted imaging lesions. IG and favorable 3-month modified Rankin Scale (mRS) score (≤ 2) were compared between patients in whom complete reperfusion (eTICI 3) was achieved with a single pass (FP group) and those for whom multiple passes were required (MP group), after matching for confounding factors. Mediation analysis was performed to examine the association between FP and 3-month mRS score, with IG as mediating variable. Results: A total of 200 patients were included, of whom 118 (28.9%) had FP complete reperfusion. In case-control analysis, the FP group had lower IG than the MP group [8.7 (5.4-12.9) ml vs. 15.2 (11-22.6) ml, respectively; P = 0.03). Favorable outcome was higher in the FP population compared to a matched MP population (70.9% vs. 53.2%, respectively; P = 0.04). FP compete reperfusion (eTICI 3) was independently associated with favorable outcome in multivariable regression analysis [odds ratio 1.86, 95% confidence interval (CI) 1.01-4.39; P = 0.04]. The effect of complete reperfusion at FP on functional outcome was explained by limited IG in mediation analysis [indirect effect: −0.32 (95% CI −0.47 to −0.09)]. Conclusion: Complete reperfusion at FP is independently associated with significant decrease in IG compared to complete reperfusion by multiple attempts, explaining better functional outcomes.

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“…In the previous neurointerventional literature, a recanalization grade greater than or equal to TICI 2b was determined as an acceptable outcome. 2 We were able to achieve TICI grade 2b or higher recanalization in 86.8% of patients. Recently, however, a call for a higher outcome standard has been made as more up-to-date literature suggests that patients with TICI grade 2b recanalization have inferior outcomes when compared to patients who achieve TICI…”

Section: Discussionmentioning

confidence: 67%

“…17 First-pass recanalization only occurs in approximately 1 in 4 patients who undergo mechanical thrombectomy, and additional retrieval attempts in the remaining 75% of patients are associated with procedural complications and worse clinical outcomes. 2 Anatomical predictors of a first-pass effect are lacking in the neurointerventional literature but could be crucial in guid-ing the development of improved retrieval devices and techniques that are individualized to each patient's unique anatomy. Upstream vessel morphology and anatomical parameters have previously been demonstrated to be associated with downstream hemodynamic consequences, but such relationships have not been explored in the context of stroke intervention for large-vessel occlusion.…”

mentioning

confidence: 99%

Cerebral vessel anatomy as a predictor of first-pass effect in mechanical thrombectomy for emergent large-vessel occlusion

Srivatsa

Duan

Sheppard

et al. 2021

Journal of Neurosurgery

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OBJECTIVEMechanical thrombectomy is effective in acute ischemic stroke secondary to emergent large-vessel occlusion, but optimal efficacy is contingent on fast and complete recanalization. First-pass recanalization does not occur in the majority of patients. The authors undertook this study to determine if anatomical parameters of the intracranial vessels impact the likelihood of first-pass complete recanalization.METHODSThe authors retrospectively evaluated data obtained in 230 patients who underwent mechanical thrombectomy for acute ischemic stroke secondary to large-vessel occlusion at their institution from 2016 to 2018. Eighty-six patients were identified as having pure M1 occlusions, and 76 were included in the final analysis. The authors recorded and measured clinical and anatomical parameters and evaluated their relationships to the first-pass effect.RESULTSThe first-pass effect was achieved in 46% of the patients. When a single device was employed, aspiration thrombectomy was more effective than stent retriever thrombectomy. A larger M1 diameter (p = 0.001), decreased vessel diameter tapering between the petrous segment of the internal carotid artery (ICA) and M1 (p < 0.001), and distal collateral grading (p = 0.044) were associated with first-pass recanalization. LASSO (least absolute shrinkage and selection operator) was used to generate a predictive model for recanalization using anatomical variables.CONCLUSIONSThe authors demonstrated that a larger M1 vessel diameter, low rate of vessel diameter tapering along the course of the intracranial ICA, and distal collateral status are associated with first-pass recanalization for patients with M1 occlusions.

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First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial

Cited by 90 publications

References 33 publications

Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective

Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective

Benefit of first‐pass complete reperfusion in thrombectomy is mediated by limited infarct growth

Cerebral vessel anatomy as a predictor of first-pass effect in mechanical thrombectomy for emergent large-vessel occlusion

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