Beyond the first pass: revascularization remains critical in stroke thrombectomy

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• The first pass effect is a novel predictor of successful outcomes following mechanical thrombectomy for stroke.
• This study investigates the impact of the first pass effect on patient outcomes and the role of revascularization success.

Purpose of the Study:

• To evaluate the association between the first pass effect and clinical outcomes in patients undergoing stroke thrombectomy.
• To assess the influence of revascularization rates on outcomes in relation to the number of passes required.

Main Methods:

• Retrospective analysis of prospectively maintained data from anterior circulation stroke thrombectomy cases (April 2012-April 2018).
• Data included demographics, NIH Stroke Scale, occlusion site, procedural details, and 90-day mRS scores.

Main Results:

• Successful revascularization rates were higher with fewer passes (87% for one pass vs. 64% for 3+ passes).
• Good functional outcomes decreased with more passes (54% for one pass vs. 29% for 3+ passes).
• In fully revascularized patients, outcome differences between pass groups were not significant.

Conclusions:

• First pass thrombectomy is associated with superior functional outcomes compared to procedures requiring multiple passes.
• Higher revascularization rates in single-pass treatments contribute to better outcomes.
• Continued focus on achieving revascularization within the first pass is crucial for optimizing stroke thrombectomy results.