First pass effect vs multiple passes complete reperfusion: A retrospective study

2021 ◽  
pp. 197140092110428
Author(s):  
Ameer E Hassan ◽  
Mahmoud Dibas ◽  
Amrou Sarraj ◽  
Sherief Ghozy ◽  
Amr Ehab El-Qushayri ◽  
...  
Keyword(s):  
Large Scale ◽  
High Volume ◽  
Functional Independence ◽  
Matched Pairs ◽  
First Pass Effect ◽  
Significant Difference ◽  
First Pass ◽  
High Volume Center ◽  
Baseline Characteristics ◽  
The Difference

Background and purpose First pass effect (FPE) is defined as achieving modified treatment in cerebral infarction (mTICI) grade 2c/3 reperfusion from the first pass and is associated with more favorable outcomes. We aimed to compare FPE and non-FPE using a large database and further compare first-pass mTICI 2b with multiple passes mTICI 3. Methods A retrospective cohort study of acute ischemic stroke patients who received mechanical thrombectomy at a high-volume center was performed. Baseline characteristics and outcomes including rates of discharge and 90-day functional independence (modified Rankin Scale ≤2), mortality, symptomatic, and asymptomatic intracerebral hemorrhage were compared. Results Of the 637 patients included, 294 achieved FPE; 161 patients had multiple passes mTICI 3 and 36 had first pass mTICI 2b. Propensity-score matching resulted in 211 matched pairs for FPE vs non-FPE, and 30 matched pairs for multiple passes mTICI 3 vs first pass mTICI 2b. The FPE group had significantly more instances of discharge (33.6% vs 19.4%, p = 0.001) and 90-day functional independence (51.7% vs 40.8%, p = 0.032), and lower rates of mortality (18.0% vs 27.5%, p = 0.027) compared to non-FPE. There was no significant difference between first pass mTICI 2b and multiple passes mTICI 3 concerning any studied outcomes. Conclusions First pass mTICI 2c/3 is safer and is associated with higher rates of functional independence. We did not observe a significant difference between first pass mTICI 2b and multiple passes mTICI 3. The limitations of this study prevent us from drawing conclusions related to the difference between them and calls for future large-scale studies to explore that further.

Abstract P545: First Pass TICI 2b versus Multiple Passes TICI 3 for Acute Ischemic Stroke Patients: Is First Pass TICI 2b Enough?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Mahmoud Dibas ◽  
Sherief Ghozy ◽  
Amr Ehab El-Qushayri ◽  
Adam A Dmytriw ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Vessel Occlusion ◽  
Single Pass ◽  
First Pass Effect ◽  
Significant Difference ◽  
First Pass ◽  
P 16 ◽  
Baseline Characteristics ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background and Objective: Prompt and complete reperfusion with mechanical thrombectomy (MT) is essential to improve outcome in acute ischemic strokes (AIS) with large vessel occlusion (LVO). Recently, first-pass effect (FPE), defined as achieving complete reperfusion with a single pass, has been emphasized as a potentially important MT target. We aimed to compare outcomes between patients who achieve mTICI 2b with first pass to those with multiple devise passes (MDP) mTICI 3. Methods: From a single comprehensive stroke center database, we retrospectively grouped LVO pts treated with MT into those who achieved mTICI 2b after a single pass and mTICI 3 after MDP. Clinical outcome (discharge and 90-day mRS), discharge NIHSS and safety (sICH, neurological worsening, mortality) were compared between the two groups. Results: Of 186 pts included, 153 (82%) achieved mTICI 3 with MDP, and 33 (18%) had mTICI 2b after a single pass. Mean age (71 vs 69), NIHSS (17 vs 16, p=0.2) were similar between the two groups. Patients with a single pass mTICI 2b had numerically higher IV tPA administration (33% vs 46%, p=.16). There was no difference in other baseline characteristics. There was no significant difference in discharge (21% vs 24.2%, p=0.65) and 90-day mRS 0-2 (24% vs 24%, p=0.5), MDP mTICI 3 and single pass mTICI 2b, respectively. Also, there was no difference in discharge NIHSS score (13.6 vs 16.7, p=0.26), mortality (16.3% vs 18.2%, p=0.8) and sICH rates (7.8% vs 18.2%, p=0.095) or neurological worsening (76.5% vs 69.7%, p=1). Conclusion: Our results did not show a significant difference between mTICI 3 with multiple passes and mTICI 2b after a single pass. Future large studies are warranted to explore the possibility of extending the first pass effect to patients who achieve mTICI 2b with a single pass.

scholarly journals Mechanical Thrombectomy in Stroke. Experience from Switching from Stent Retriever Only to Stent Retriever Combined with Aspiration Catheter

2021 ◽  
Vol 10 (9) ◽  
pp. 1802
Author(s):  
Grzegorz Meder ◽  
Paweł Żuchowski ◽  
Wojciech Skura ◽  
Violetta Palacz-Duda ◽  
Milena Świtońska ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Statistical Significance ◽  
Stent Retriever ◽  
Single Center Experience ◽  
Significant Difference ◽  
First Pass ◽  
Need To Evaluate ◽  
The Difference

Endovascular treatment is a rapidly evolving technique; therefore, there is a constant need to evaluate this method and its modifications. This paper discusses a single-center experience and the results of switching from the stent retriever only (SO) mechanical thrombectomy (MT) to the combined approach (CA), with a stent retriever and aspiration catheters. Methods: The study involved a retrospective analysis of 70 patients undergoing MT with the use of either SO or CA. The primary endpoint was the frequency of perfect reperfusion defined as grade 3 of the modified Thrombolysis in Cerebral Infarction scale (mTICI) after the first pass. The secondary endpoints were the procedure success, defined as mTICI grades 2b-3; time of the procedure; clinical outcome, measured by 90 days’ modified Rankin Scale (mRS) score; Δ NIHSS, defined as the difference between National Institutes of Health Stroke Scale (NIHSS) score at patients’ admission and discharge; and the total number of device passes. Results: Out of the 70 patients included, 33 were treated with SO and 37 with CA. In both groups, a total number of 42 patients received intravenous recombined tissue plasminogen activator (iv-rTPA: 20 patients (60.6%) in the SO group and 22 patients (59.5%) in the CA group (p = 1.000). There was a significant difference between the groups regarding first-pass success rate, with 46% in the CA group and 18% in the SO group, (OR 3.83, 95% CI 1.28 to 11.44, p = 0.016). Complete procedure success tended to be more frequent in the CA group than in the SO group—94.6% vs. 84.8% (OR 3.13, 95% CI 0.56 to 17.34, p = 0.193)—and CA tended to require a lower number of passes than SO (mean 1.76 vs. 2.09 passes per procedure, p = 0.114), yet these differences did not reach statistical significance. Mean duration of the procedure was significantly shorter in the CA group than in the SO group (49 min vs. 64 min, p = 0.017). There was a significant difference in clinical outcomes, with higher Δ NIHSS (9.3 in the CA group vs. 6.7 in the SO group, p = 0.025) after the procedure and 90-day mRS (median 2 in the CA group vs. 4 in the SO group, p = 0.031). Conclusions: Combining stent retrievers with aspiration catheters may offer a beneficial effect on angiographic results and clinical outcomes in stroke patients undergoing endovascular treatment.

First attempt recanalization with ADAPT: rate, predictors, and outcome

2018 ◽  
Vol 11 (7) ◽  
pp. 641-645 ◽  
Author(s):  
Mohammad Anadani ◽  
Ali Alawieh ◽  
Jan Vargas ◽  
Arindam Rano Chatterjee ◽  
Aquilla Turk ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Hemorrhagic Transformation ◽  
Lower Mortality ◽  
Anterior Circulation ◽  
Tandem Occlusion ◽  
First Pass ◽  
Baseline Characteristics ◽  
Iv Tpa

IntroductionThe rate of first-attempt recanalization (FAR) with the newer-generation thrombectomy devices, and more specifically with aspiration devices, is not well known. Moreover, the effect of FAR on outcomes after mechanical thrombectomy is not properly understood.ObjectiveTo report the rate of FAR using a direct aspiration first pass technique (ADAPT), investigate the association between FAR and outcomes, and identify the predictors of FAR.MethodsThe ADAPT database was used to identify a subgroup of patients in whom FAR was achieved. Baseline characteristics, procedural, and postprocedural variables were collected. Outcome measures included 90-day modified Rankin scale (mRS) score, mortality, and hemorrhagic complications. Multivariate logistic regression was used to identify FAR predictors.ResultsA total of 524 patients was included of whom 178 (34.0%) achieved FAR. More patients in the FAR group than in the non-FAR group received IV tPA (46.6% vs 37.6%; p<0.05). For the functional outcome, higher proportions of patients in the FAR group achieved functional independence (mRS score 0–2; 53% vs 37%; p<0.05). Additionally, we observed lower mortality and hemorrhagic transformation rates in the FAR group than the non-FAR group. Independent predictors of FAR in the anterior circulation were pretreatment IV tPA, non-tandem occlusion, and use of larger reperfusion catheters (Penumbra, ACE 64–68). Independent predictors of FAR in the posterior circulation were diabetes, onset-to-groin time, and cardioembolic etiology.ConclusionFAR was associated with better functional outcome and lower mortality rate. When ADAPT is used, a larger aspiration catheter and pretreatment IV tPA should be employed when indicated.

scholarly journals Study on the Distribution Characteristics and Influencing Factors of Homocysteine in the Physical Examination Population

2021 ◽  
Author(s):  
Fang Bao ◽  
Ming Cui ◽  
Xiuying Shi ◽  
Shaoqing Ju ◽  
Hui Cong
Keyword(s):  
Blood Pressure ◽  
Physical Examination ◽  
Large Scale ◽  
Kidney Injury ◽  
Scientific Basis ◽  
Cerebrovascular Diseases ◽  
Health Examination ◽  
Significant Difference ◽  
The Difference

Abstract Background: Homocysteine (Hcy) is considered to be an independent risk factor for cardiovascular and cerebrovascular diseases. No study has evaluated the distribution of Hcy on a large-scale health examination. Accordingly, this study aimed to investigate the level and distribution of Hcy in the healthy physical examination population and the correlation with other biomarkers, and analyzed for cardiovascular and other diseases. The prevention provides an important scientific basis.Methods: From February 2017 to April 2020, 8063 medical examination populations were selected for analysis. Determination of serum Hcy, TC, TG, LDL-c, HDL-c, ALT, ALP, γ-GT, TBIL, GLU, urea, Cr, UA and related metabolic risk factors. According to the multivariate regression model of age, gender, smoking, drinking, body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP), the relationship between Hcy and other biochemical indicators was evaluated. Results: Among 8063 cases, the age, BMI, SBP and DBP of the high-Hcy group were higher than those of the low-Hcy group, the difference was statistically significant (P<0.05), and the proportion of males, smoking and drinking were higher than the low In the Hcy group, the difference was statistically significant (P<0.05); the ALT, ALP, γ-GT, TBIL, Urea, Cr, UA, and TG in the high Hcy group were higher than those in the low Hcy group, and the difference was statistically significant (P<0.05 ); HDL-c in the high-Hcy group was lower than that in the low-Hcy group, and the difference was statistically significant (P<0.05). There was no statistically significant difference in TC, LDL-c, and GLU between the high- and low-Hcy groups (P>0.05). In multivariate analysis, lnHDL-C was negatively correlated with lnHcy (β=-0.038, SE=0.016, P<0.05), lnCr was positively correlated with lnHcy (β=0.055, SE=0.016, P<0.05), lnUA and lnHcy were positive correlation (β=0.043, SE=0.019, P<0.05). Conclusion: Hcy is closely related to HDL-c, Cr and UA, which indicates that Hcy may affect the metabolism of HDL-c and UA, and can also be used as an auxiliary diagnostic index for kidney injury.

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.

scholarly journals Large Scale Star Formation: Density Waves, Superassociations and Propagation

1987 ◽  
Vol 115 ◽  
pp. 457-481 ◽  
Author(s):  
Bruce G. Elmegreen
Keyword(s):  
Star Formation ◽  
Large Scale ◽  
Density Waves ◽  
Spiral Arms ◽  
Gravitational Instabilities ◽  
Significant Difference ◽  
Star Formation In Galaxies ◽  
The Difference ◽  
The Waves

The hypothesis that density waves trigger star formation is critically examined. Much of the former evidence in favor of the hypothesis is shown to be inconsistent with modern observations. A comparison between galaxies with and without density waves reveals no significant difference in their star formation rates. A new role for density waves in the context of star formation might be based on four principles: 1. density waves are intrinsically strong, 2. the gas is compressed more than the stars in the wave, 3. star formation follows the gas, with no preferential trigger related to the wave itself, and 4. regions of star formation are larger in the spiral arms than they are between the arms. This new role for density waves is primarily one of organization: the waves place most of the gas in the arms, so most of the star formation is in the arms too. The waves also promote the coagulation of small clouds into large cloud complexes, or superclouds, by what appears to be a combination of collisional agglomeration and large-scale gravitational instabilities. Special regions where density waves do trigger a true excess of star formation are discussed, and possible reasons for the difference between these triggering waves and the more common, organizing, waves are mentioned. Other aspects of large-scale star formation, such as the occurrence of kiloparsec-size regions of activity and kiloparsec-range propagation, are illustrated with numerous examples. The importance of these largest scales to the overall mechanism of star formation in galaxies is emphasized.

scholarly journals Talar Prosthesis Template: A Cadaveric Study of the Size Discrepancy between Right and Left Tali

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0009
Author(s):  
Chayanin Angthong ◽  
Prasit Rajbhandari ◽  
Attaporn Piyapanee ◽  
Sjoerd Antoine Sebastian Stufkens
Keyword(s):  
Underlying Disease ◽  
Dome Height ◽  
Matched Pair ◽  
P Value ◽  
Matched Pairs ◽  
Crystal Deposition ◽  
Significant Difference ◽  
Size Discrepancy ◽  
Pair Method ◽  
The Difference

Category: Ankle Introduction/Purpose: Nowadays, the talar prosthesis has been designed for its size and shape based on the data of its contralateral talus. However, little is known about the discrepancy of the sizes between right and left tali. The present study was to demonstrate the difference between right and left talar sizes in the matched pairs of cadaveric specimens. Methods: A total of twenty four tali as twelve matched pairs of tali were collected in this study. All tali were measured with a Vernier caliper which provided the data for further analyzed regarding the talar size. The data was calculated to demonstrate the difference between right and left talar sizes in a matched pair method included the general size of talus. There was a talus which was not used in the data calculation due to its crystal deposition from an underlying disease of a cadaver. Results: In overall, an average talar length (TaL) was 53.5 millimeters (mm). An average talar dome height (TaH) was 31.2 mm. An average talar body width (TaW) was 41.3 mm. The average anterior trochlear width (TrAW), middle trochlear width (TrMW), posterior trochlear width (TrPW), and trochlear length (TrL) were 31.8, 31.2, 28.3, and 30.7 mm. Based on eleven matched pairs of tali, the paired T-test showed the significant difference of TaH (P-value: 0.019), TrMW (P-value: 0.027), and TrPW (P-value: 0.016) between right and left tali. Conclusion: The present study demonstrated the discrepancy of right and left talar sizes about three important parameters in the matched pairs of tali. Talar prosthesis template may be necessary to use other method to determine its size for the prosthesis manufacturing in addition to the utilization of measured profiles from the contralateral talus.

Early reperfusion and clinical outcomes in patients with M2 occlusion: pooled analysis of the PROACT II, IMS, and IMS II studies

2014 ◽  
Vol 121 (6) ◽  
pp. 1354-1358 ◽  
Author(s):  
Ralph Rahme ◽  
Sharon D. Yeatts ◽  
Todd A. Abruzzo ◽  
Lincoln Jimenez ◽  
Liqiong Fan ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Functional Independence ◽  
Pooled Analysis ◽  
Modified Rankin Scale ◽  
Early Reperfusion ◽  
Glucose Levels ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
The Impact

Object The role of endovascular therapy in patients with acute ischemic stroke and a solitary M2 occlusion remains unclear. Through a pooled analysis of 3 interventional stroke trials, the authors sought to analyze the impact of successful early reperfusion of M2 occlusions on patient outcome. Methods Patients with a solitary M2 occlusion were identified from the Prolyse in Acute Cerebral Thromboembolism (PROACT) II, Interventional Management of Stroke (IMS), and IMS II trial databases and were divided into 2 groups: successful reperfusion (thrombolysis in cerebral infarction [TICI] 2–3) at 2 hours and failed reperfusion (TICI 0–1) at 2 hours. Baseline characteristics and clinical outcomes were compared. Results Sixty-three patients, 40 from PROACT II and 23 from IMS and IMS II, were identified. Successful early angiographic reperfusion (TICI 2–3) was observed in 31 patients (49.2%). No statistically significant difference in the rates of intracerebral hemorrhage (60.9% vs 47.6%, p = 0.55) or mortality (19.4% vs 15.6%, p = 0.75) was observed. However, there was a trend toward higher incidence of symptomatic hemorrhage in the TICI 2–3 group (17.4% vs 0%, p = 0.11). There was also a trend toward higher baseline glucose levels in this group (151.5 mg/dl vs 129.6 mg/ dl, p = 0.09). Despite these differences, the rate of functional independence (modified Rankin Scale Score 0–2) at 3 months was similar (TICI 2–3, 58.1% vs TICI 0–1, 53.1%; p = 0.80). Conclusions A positive correlation between successful early reperfusion and clinical outcome could not be demonstrated for patients with M2 occlusion. Irrespective of reperfusion status, such patients have better outcomes than those with more proximal occlusions, with more than 50% achieving functional independence at 3 months.

scholarly journals Comparing different thrombectomy techniques in five large-volume centers: a ‘real world’ observational study

2017 ◽  
Vol 10 (6) ◽  
pp. 525-529 ◽  
Author(s):  
Amélie Carolina Hesse ◽  
Daniel Behme ◽  
André Kemmling ◽  
Antonia Zapf ◽  
Nils Große Hokamp ◽  
...  
Keyword(s):  
High Volume ◽  
Stent Retriever ◽  
Large Vessel ◽  
Combined Approach ◽  
Large Vessel Occlusion ◽  
Primary Analysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Significant Difference ◽  
First Pass

Background and purposeThrombectomy has become the standard of care for acute ischaemic stroke due to large vessel occlusion. Aim of this study was to compare the radiological outcomes and time metrics of the various thrombectomy techniques.MethodsIn this retrospective, multicenter study we analysed the data of 450 patients with occlusion of the anterior circulation, treated in five high-volume center from 2013 to 2016. The treatment techniques were divided in three categories: first-pass use of a large-bore aspiration-catheter; first-pass use of a stent-retriever; and primary combined approach (PCA) of an aspiration-catheter and stent-retriever. Primary endpoints were successful reperfusion and groin to reperfusion time. Secondary endpoints were the number of attempts and occurrence of emboli in new territory (ENT). The primary analysis was based on the intention to treat groups (ITT).ResultsThe ITT-analysis showed significantly higher reperfusion rates, with 86% of successful reperfusion in the PCA-group compared with 73% in the aspiration group and 65% in the stent-retriever group. There was no significant difference in groin to reperfusion time regarding the used technique. The secondary analysis showed an impact of the technique on the number of attempts and the occurrence of ENTs. Lowest ENT rates and attempts were reported with the combined approach.ConclusionsThe combined first-pass deployment of a stent-retriever and an aspiration-catheter was the most effective technique for reperfusion of anterior circulation large vessel occlusion. Our results correlate with the latest single-centrere studies, reporting very high reperfusion rates with PCA variations.

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.

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