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First Pass Effect01:12

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Presystemic elimination, or the first-pass effect, is the metabolism of drugs that reduces their effective concentration at the site of action. Apart from the first-pass effect, the systemic bioavailability of the drug is also reduced by other factors, including incomplete absorption or chemical degradation of drugs.
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Integral membrane proteins are tightly associated with the cell membrane and play a crucial role in cell communication, signaling, adhesion, and transport of the molecules. Some integral membrane proteins are present only in the membrane monolayer. For example, the enzyme fatty acid amide hydrolase is present in the cytoplasmic side of the membrane monolayer. In contrast, another type of integral membrane protein, also known as a transmembrane protein, spans across the membrane. Transmembrane...
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Insertion of Single-pass Transmembrane Proteins in the RER01:26

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First Pass Effect: A New Measure for Stroke Thrombectomy Devices.

Osama O Zaidat1, Alicia C Castonguay2, Italo Linfante2

  • 1From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke's Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J.D.E.); Alexian Brothers Medical Center, Elk Grove Village, IL (T.W.M., F.A.M.); Oregon Health and Science University, Portland (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown (A.T.R.); Departments of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Department of Neurosurgery, Presence Saint Joseph Medical Center, Joliet, IL (A.B.); Department of Neurology (T.N.N.), Department of Neurosurgery (T.N.N.), and Department of Radiology (T.N.N.), Boston Medical Center, MA; Los Robles Medical Center, Thousand Oaks, CA (M.A.T.); University of Kansas Medical Center, Kansas City (M.G.A.); Texas Stroke Institute, Dallas-Forth Worth (A.J.Y, V.J.); Department of Neurology, University of Texas Medical Branch, Galveston (H.S.); Department of Neurology (R.N.), Department of Neurosurgery (R.N.), and Department of Radiology (R.N.), UT Southwestern Medical Center, Dallas, TX; Baptist Health System, Louisville, KY (A.A.-C.); Department of Neurosurgery, University of Texas Medical School, Houston (P.R.C); Department of Neurosurgery, Methodist Neurological Institute, Houston, TX (G.W.B.); Department of Neurology (C.-H.J.S., R.G.N.), Department of Neurosurgery (C.-H.J.S., R.G.N.), and Department of Radiology (C.-H.J.S., R.G.N.), Emory University School of Medicine, Atlanta, GA; and SSM Health, St. Louis, MO (A.N.). oozaidat@mercy.com.

Stroke
|February 21, 2018
PubMed
Summary

Achieving the first pass effect (FPE) in acute ischemic stroke thrombectomy means complete vessel recanalization on the first attempt. This significantly improves patient outcomes and is more likely with specific devices and occlusion locations.

Keywords:
Solitairefirst passrecanalizationstent retrieverstrokethrombectomy

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Area of Science:

  • Interventional Neurology
  • Vascular Neurology
  • Medical Device Technology

Background:

  • Fast and complete recanalization is crucial for acute ischemic stroke outcomes.
  • The first pass effect (FPE) is a new metric for device efficacy, defined as complete recanalization in one pass.

Purpose of the Study:

  • To analyze the incidence, predictors, and clinical outcomes associated with the first pass effect (FPE).
  • To evaluate FPE as a measure of newer generation thrombectomy device performance.

Main Methods:

  • Retrospective analysis of the North American Solitaire Acute Stroke Registry database.
  • Comparison of baseline characteristics and clinical outcomes (90-day mRS, NIHSS, mortality, sICH) between FPE and non-FPE groups.
  • Multivariate analyses to identify FPE predictors and its independent impact on outcomes.

Main Results:

  • FPE was achieved in 25.1% of 354 patients.
  • FPE was associated with more middle cerebral artery occlusions and fewer internal carotid artery occlusions.
  • Use of balloon guide catheters was higher in the FPE group (64.0% vs 34.7%), and time to revascularization was faster (34 vs 60 min).
  • FPE independently predicted good clinical outcome (mRS ≤2; OR, 1.7; P=0.013).
  • Predictors of FPE included balloon guide catheter use and non-internal carotid artery terminus occlusion.

Conclusions:

  • Achieving FPE with thrombectomy devices is linked to significantly better clinical outcomes.
  • FPE is more common with balloon-guided catheters and less likely in internal carotid artery terminus occlusions.