first pass effect
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Author(s):  
Seán T Fitzgerald ◽  
Liam Mullins ◽  
Kevin Connolly ◽  
John Thornton ◽  
Raul G Nogueira

Introduction : Previous studies demonstrated that both the location of the distal access catheter tip and angle of aspiration have a significant impact on revascularization outcomes 1,2 . A direct aspiration First‐Pass technique (ADAPT) with large‐bore aspiration catheters has emerged as a fast, safe, and effective thrombectomy technique. Maximizing the catheter‐to‐vessel size has previously been shown to enhance distal flow control resulting in improved in‐vitro revascularization rates for aspiration thrombectomy 3 . However, physicians differ in their preference for aspiration catheter tip placement, typically either positioning the catheter tip at the ‘face’ of the clot or advancing the catheter tip into the clot to engage it. We hypothesize that sizing the aspiration catheter outer diameter (OD) to the inner diameter (ID) of the vessel and embedding the catheter tip in the clot may result in ‘pinning’ fragments of clot between the catheter and vessel wall, thereby negatively affecting revascularization outcomes. Withdrawal of the aspiration catheter under continuous aspiration may mitigate this effect. We investigate the influence of catheter tip position and aspiration technique on ADAPT revascularization success with various sizes of aspiration catheters. Methods : Two clot analogues phenotypes (RBC‐Rich and Fibrin/Platelet‐Rich) were created from human blood and used to form occlusions in an In‐vitro thrombectomy model as previously described 4 . Two catheter tip positions and three techniques were investigated; 1). Catheter tip proximal to the face of the clot followed by conventional aspiration, 2). Catheter tip ‘embedded’ into the clot followed by conventional aspiration, and 3). Catheter tip ‘embedded’ into the clot followed by conventional aspiration and aspiration on catheter withdrawal even if clot ingestion occurred. Two aspiration catheters were investigated; Millipede 088’’ (Perfuze Ltd) and SOFIA Plus (Terumo). Multiple replicates of each test were performed. Endpoints were First‐Pass Effect and procedural‐related distal emboli from 200–1000µm. Results : Maximizing the catheter‐to‐vessel size increases success of the ADAPT approach when the tip is located proximal to the clot face (Fig 1 A&B); Millipede 088 achieves a higher First‐Pass Effect rate than SOFIA Plus. Sizing the catheter‐to‐vessel and embedding the catheter tip into the clot (Figure 1C) results in ‘pinning’ of clot fragments between the catheter and vessel wall (Figure 1D) resulting in lower rates of First‐Pass Effect. Withdrawing the catheter under continuous aspiration increases the success of the embedding method by capturing ‘pinned’ fragments. Conclusions : The position of the aspiration catheter tip and aspiration technique used both influence the success of ADAPT procedures. Sizing the catheter‐to‐vessel results in improved revascularization. However, embedding the tip into the clot when the vessel is similar in ID to the catheter OD may reduce First‐Pass Effect rates. To optimize the rates of First‐Pass Effect, aspiration catheters may be positioned at the proximal face of the clot or retracted under continuous aspiration if wedged into the clot.


2021 ◽  
Vol 12 ◽  
Author(s):  
Marion John Oliver ◽  
Emily Brereton ◽  
Muhib A. Khan ◽  
Alan Davis ◽  
Justin Singer

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.


Author(s):  
Keigo Shigeta ◽  
Kentaro Suzuki ◽  
Yuji Matsumaru ◽  
Masataka Takeuchi ◽  
Masafumi Morimoto ◽  
...  

2021 ◽  
pp. 197140092110428
Author(s):  
Ameer E Hassan ◽  
Mahmoud Dibas ◽  
Amrou Sarraj ◽  
Sherief Ghozy ◽  
Amr Ehab El-Qushayri ◽  
...  

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.


Stroke ◽  
2021 ◽  
Author(s):  
Mathilde Aubertin ◽  
David Weisenburger-Lile ◽  
Benjamin Gory ◽  
Sébastien Richard ◽  
Raphael Blanc ◽  
...  

Background and Purpose: In the settings of thrombectomy, the first-pass effect (FPE), defined by a complete recanalization after one pass with no rescue therapy, has been shown to be associated with an improved outcome. As this phenomenon has been predominantly described in anterior circulation strokes, we aimed to study the prevalence, outcomes, and predictors of FPE in patients with a basilar artery occlusion. Methods: From a prospective multicentric registry, we collected the data of all consecutive basilar artery occlusion patients who underwent thrombectomy and compared the outcomes of patients who achieved FPE and those who did not. We also compared FPE patients with those who achieved a complete recanalization with >1 pass. Finally, a multivariate analysis was performed to determine the predictors of FPE. Results: Data from 280 patients were analyzed in our study, including 84 of 280 patients (30%) with an atheromatous etiology. An FPE was achieved in 93 patients (33.2%), with a significantly higher proportion of good outcomes (modified Rankin Scale score 0-2 at 3 months) and lower mortality than non-FPE patients. An FPE was also associated with improved outcomes compared with patients who went on to have full recanalization with >1 pass. Contact aspiration as first-line strategy was a strong predictor of FPE, whereas baseline antiplatelets and atheromatous etiology were negative predictors. Conclusions: In our study, an FPE was achieved in approximately one-third of patients with a basilar artery occlusion and was associated with improved outcomes. More research is needed to improve devices and techniques to increase the incidence of FPE. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03776877.


Author(s):  
G Meeks ◽  
O Zaidat ◽  
A Hassan ◽  
J Fifi ◽  
A Yoo ◽  
...  

Author(s):  
T Jovin ◽  
RG Nogueira ◽  
AH Siddiqui ◽  
AJ Yoo ◽  
RA Hanel ◽  
...  

2021 ◽  
Vol 89 ◽  
pp. 33-38
Author(s):  
N. Abdullayev ◽  
V. Maus ◽  
D. Behme ◽  
U.B. Barnikol ◽  
S. Kutschke ◽  
...  

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