Influence of first-pass effect on recanalization outcomes in the era of mechanical thrombectomy: a systemic review and meta-analysis

2020 ◽  
Author(s):  
Xuesong Bai ◽  
Xiao Zhang ◽  
Wuyang Yang ◽  
Yinhang Zhang ◽  
Tao Wang ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Systemic Review ◽  
First Pass Effect ◽  
First Pass

Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes

2021 ◽  
Vol 13 (3) ◽  
pp. 212-216
Author(s):  
Mehdi Abbasi ◽  
Yang Liu ◽  
Seán Fitzgerald ◽  
Oana Madalina Mereuta ◽  
Jorge L Arturo Larco ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Literature Search ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Neurologic Outcome ◽  
Single Pass ◽  
First Pass Effect ◽  
Symptomatic Intracerebral Hemorrhage ◽  
First Pass ◽  
Good Neurologic Outcome

BackgroundFirst pass effect (FPE) in mechanical thrombectomy is thought to be associated with good clinical outcomes.ObjectiveTo determine FPE rates as a function of thrombectomy technique and to compare clinical outcomes between patients with and without FPE.MethodsIn July 2020, a literature search on FPE (defined as modified Thrombolysis in Cerebral Infarction (TICI) 2c–3 after a single pass) and modified FPE (mFPE, defined as TICI 2b–3 after a single pass) and mechanical thrombectomy for stroke was performed. Using a random-effects meta-analysis, we evaluated the following outcomes for both FPE and mFPE: overall rates, rates by thrombectomy technique, rates of good neurologic outcome (modified Rankin Scale score ≤2 at day 90), mortality, and symptomatic intracerebral hemorrhage (sICH) rate.ResultsSixty-seven studies comprising 16 870 patients were included. Overall rates of FPE and mFPE were 28% and 45%, respectively. Thrombectomy techniques shared similar FPE (p=0.17) and mFPE (p=0.20) rates. Higher odds of good neurologic outcome were found when we compared FPE with non-FPE (56% vs 41%, OR=1.78) and mFPE with non-mFPE (57% vs 44%, OR=1.73). FPE had a lower mortality rate (17% vs 25%, OR=0.62) than non-FPE. FPE and mFPE were not associated with lower sICH rate compared with non-FPE and non-mFPE (4% vs 18%, OR=0.41 for FPE; 5% vs 7%, OR=0.98 for mFPE).ConclusionsOur findings suggest that approximately one-third of patients achieve FPE and around half of patients achieve mFPE, with equivalent results throughout thrombectomy techniques. FPE and mFPE are associated with better clinical outcomes.

Abstract P488: The Impact of First Pass Effect on Acute Ischemic Stroke Clinical Outcomes: Why We Need to Continue to Improve Mechanical Thrombectomy?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Mahmoud Dibas ◽  
Amr Ehab El-Qushayri ◽  
Sherief Ghozy ◽  
Adam A Dmytriw ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Vessel Occlusion ◽  
First Pass Effect ◽  
Improved Outcomes ◽  
First Pass ◽  
The Impact

Background: Mechanical thrombectomy (MT) has significantly improved outcomes of acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO). The first-pass effect (FPE), defined as achieving complete reperfusion (mTICI3/2c) with a single pass, was reported to be associated with higher functional independence rates following EVT and has been emphasized as an important procedural target. We compared MT outcomes in patients who achieved FPE to those who did not in a real world large database. Method: A retrospective analysis of LVO pts who underwent MT from a single center prospectively collected database. Patients were stratified into those who achieved FPE and non-FPE. The primary outcome (discharge and 90 day mRS 0-2) and safety (sICH, mortality and neuro-worsening) were compared between the two groups. Results: Of 580 pts, 261 (45%) achieved FPE and 319 (55%) were non-FPE. Mean age was (70 vs 71, p=0.051) and mean initial NIHSS (16 vs 17, p=0.23) and IV tPA rates (37% bs 36%, p=0.9) were similar between the two groups. Other baseline characteristics were similar. Non-FPE pts required more stenting (15% vs 25%, p=0.003), and angioplasty (19% vs 29%, p=0.01). The FPE group had significantly more instances of discharge (33% vs 17%, p<0.001), and 90-day mRS score 0-2 (29% vs 20%, p<0.001), respectively. Additionally, the FPE group had a significant lower mean discharge NIHSS score (12 vs 17, p<0.001). FPE group had better safety outcomes with lower mortality (14.2% vs 21.6%, p=0.03), sICH (5.7% vs 13.5, p=0.004), and neurological worsening (71.3% vs 78.4%, p=0.02), compared to the non-FPE group. Conclusion: Patients with first pass complete or near complete reperfusion with MT had higher functional independence rates, reduced mortality, symptomatic hemorrhage and neurological worsening. Improvement in MT devices and techniques is vital to increase first pass effect and improve clinical outcomes.

Identifying the predictors of first-pass effect and its influence on clinical outcome in the setting of endovascular thrombectomy for acute ischemic stroke: Results from a multicentric prospective registry

2020 ◽  
pp. 174749302092305 ◽  
Author(s):  
Federico Di Maria ◽  
Maéva Kyheng ◽  
Arturo Consoli ◽  
Jean-Philippe Desilles ◽  
Benjamin Gory ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Lower Systolic Blood Pressure ◽  
Excellent Outcome ◽  
First Pass Effect ◽  
First Pass ◽  
Thrombectomy Device

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.

scholarly journals Trevo 6 × 25mm vs. 4 × 30mm in Mechanical Thrombectomy of M1 LVO

2021 ◽  
Vol 12 ◽  
Author(s):  
Marion John Oliver ◽  
Emily Brereton ◽  
Muhib A. Khan ◽  
Alan Davis ◽  
Justin Singer
Keyword(s):  
Mechanical Thrombectomy ◽  
Perioperative Complications ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
First Pass Effect ◽  
Significant Difference ◽  
First Pass ◽  
Stent Retrievers ◽  
Complications And Mortality

Objectives: Our primary objective was to determine the successful rate of recanalization of M1 large vessel occlusion using either the Trevo 4 × 30 mm or 6 × 25 mm stent during mechanical thrombectomy. Our secondary objectives were to determine differences between the use of these two stent retrievers regarding first-pass effect, periprocedural complications, and mortality in the first 90 days.Methods: This is a retrospective cohort study. Data regarding the stent used, recanalization, number of passes, periprocedural complications, and mortality were determined via our mechanical thrombectomy database along with chart review.Conclusion: When comparing Trevo 4 × 30 mm to 6 × 25 mm stent retrievers used in mechanical thrombectomy for middle cerebral artery large-vessel occlusion causing stroke, there is no statistically significant difference in successful recanalization rates, first-pass effect, perioperative complications, or mortality at 90 days. Studies like this will hopefully lead to further prospective, randomized controlled trials that will help show experts in the field an additional way to perform this procedure effectively and safely.

scholarly journals Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis

2017 ◽  
Vol 10 (4) ◽  
pp. 335-339 ◽  
Author(s):  
Waleed Brinjikji ◽  
Robert M Starke ◽  
M Hassan Murad ◽  
David Fiorella ◽  
Vitor M Pereira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Procedure Time ◽  
Weighted Mean ◽  
First Pass ◽  
Number Of Passes

Background and purposeFlow arrest with balloon guide catheters (BGCs) is becoming increasingly recognized as critical to optimizing patient outcomes for mechanical thrombectomy. We performed a systematic review and meta-analysis of the literature for studies that compared angiographic and clinical outcomes for patients who underwent mechanical thrombectomy with and without BGCs.Materials and methodsIn April 2017 a literature search on BGC and mechanical thrombectomy for stroke was performed. All studies included patients treated with and without BGCs using modern techniques (ie, stent retrievers). Using random effects meta-analysis, we evaluated the following outcomes: first-pass recanalization, Thrombolysis In Cerebral Infarction (TICI) 3 recanalization, TICI 2b/3 recanalization, favorable outcome (modified Rankin Scale (mRS) 0–2), mortality, and mean number of passes and procedure time.ResultsFive non-randomized studies of 2022 patients were included (1083 BGC group and 939 non-BGC group). Compared with the non-BGC group, patients treated with BGCs had higher odds of first-pass recanalization (OR 2.05, 95% CI 1.65 to 2.55), TICI 3 (OR 2.13, 95% CI 1.43 to 3.17), TICI 2b/3 (OR 1.54, 95% CI 1.21 to 1.97), and mRS 0–2 (OR 1.84, 95% CI 1.52 to 2.22). BGC-treated patients also had lower odds of mortality (OR 0.52, 95% CI 0.37 to 0.73) compared with non-BGC patients. The mean number of passes was significantly lower for BGC-treated patients (weighted mean difference −0.34, 95% CI−0.47 to −0.22). Mean procedure time was also significantly shorter for BGC-treated patients (weighted mean difference −7.7 min, 95% CI−9.0to −6.4).ConclusionsNon-randomized studies suggest that BGC use during mechanical thrombectomy for acute ischemic stroke is associated with superior clinical and angiographic outcomes. Further randomized trials are needed to confirm the results of this study.

Significance of angiographic clot meniscus sign in mechanical thrombectomy of basilar artery stroke

2019 ◽  
Vol 12 (5) ◽  
pp. 477-482
Author(s):  
Sung Hyun Baik ◽  
Joon Whi Kim ◽  
Byung Moon Kim ◽  
Dong Joon Kim
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Side Wall ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Procedure Time ◽  
First Pass Effect ◽  
First Pass ◽  
Number Of Passes ◽  
The Relationship

IntroductionThe relationship between the occlusive clot morphology and the efficacy of mechanical thrombectomy (MT) in basilar artery occlusion (BAO) is not well known. Our aim was to evaluate the clinical significance of the clot meniscus sign in patients with acute BAO.Methods89 patients with acute BAO who underwent MT were retrospectively analyzed. The clot meniscus sign was defined as meniscoid/tram-track like antegrade side-wall contrast opacification of the thrombus. Patients were assigned to two groups based on the presence of the clot meniscus sign. The treatment and clinical outcomes were compared.ResultsThe clot meniscus sign was diagnosed in 62.9% (53/89) of the patients. The meniscus sign (+) group showed a shorter procedure time (55 vs 85 min; p=0.045), higher rate of successful recanalization (89.3% vs 63.6%, p=0.004), higher incidence of first pass effect (32.1% vs 6.1%, p=0.004), and lower number of passes (2 vs 3; p=0.042) when compared with the meniscus sign (−) group. The procedure time (OR 0.972, 95% CI 0.962 to 0.992; p=0.003) and clot meniscus sign (OR 7.920, 95% CI 1.769 to 35.452; p=0.007) were independent predictors of successful recanalization.ConclusionThe clot meniscus sign is related to high first pass effect and short procedure time and is a reliable predictor of successful recanalization in patients with acute BAO.

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