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Updated: Oct 25, 2025
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Diminishing returns with successive device passes in mechanical thrombectomy for stroke
Jennifer A Kosty1, Christopher P Carroll2, Sandeep Kandregula1
1Department of Neurosurgery, Ochsner LSU Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
Insights
More device passes during mechanical thrombectomy for emergent large vessel occlusion (ELVO) correlate with decreased angiographic improvement and worse clinical outcomes. Limiting passes may improve patient results in ELVO treatment.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Mechanical thrombectomy (MT) is a key treatment for emergent large vessel occlusion (ELVO).
- Multiple device passes during MT are linked to increased complications and poorer functional outcomes.
- Optimizing the number of device passes is crucial for improving MT efficacy in ELVO.
Purpose of the Study:
- To investigate the association between the number of device passes, complications, and both angiographic and clinical outcomes in MT for ELVO.
- To identify predictors of unfavorable clinical outcomes in patients undergoing MT for ELVO.
Main Methods:
- A single-center retrospective cohort study analyzed individual device passes during MT.
- Evaluated changes in Thrombolysis in Cerebral Infarction (TICI) scores, successful revascularization (TICI 2b or 3), and complications.
- Compared outcomes across groups with varying numbers of passes and used multivariate analysis to assess risk factors for unfavorable outcomes (90-day modified Rankin Scale > 2).
Main Results:
- Successful revascularization was achieved in 75% of 163 patients; 36% required only one pass.
- Angiographic improvement likelihood significantly decreased after the second pass (p < 0.001).
- Increased passes correlated with higher post-procedural NIHSS scores, mortality, and unfavorable 90-day outcomes. Internal carotid artery (ICA) thrombus and failed revascularization were significant predictors of unfavorable outcomes.
Conclusions:
- Angiographic improvement in ELVO patients significantly declines after the second device pass.
- A higher number of device passes is associated with poorer clinical outcomes following mechanical thrombectomy.
- Strategies to minimize device passes may enhance functional recovery in ELVO patients.
Background:
Multiple device passes are associated with complications and poor functional outcomes following mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO).
Objective:
To characterize the relationship between number of device passes, complications, angiographic outcomes, and clinical outcomes in MT for ELVO.
Methods:
This is a single-center, retrospective cohort study. Individual device passes for MT were evaluated for any change in Thrombolysis in Cerebral Infarction (TICI) score, successful revascularization (TICI 2b or 3), and complications. Outcomes were compared among groups requiring multiple passes with various cut-off points. Risk factors for unfavorable clinical outcome [90 day modified Rankin Scale > 2] were assessed using multivariate analysis.
Results:
Successful revascularization was achieved in 75% of 163 patients and 36% required only one device pass. After the second pass, the likelihood of angiographic improvement significantly decreased (p < 0.001). Using multiple cut-off points, higher post-procedural NIHSS scores, mortality rates, and unfavorable 90-day outcomes were associated with a greater number of passes. Multivariate analysis revealed ICA thrombus (comparison: M2, OR: 25, 95% CI 2-275, p = 0.01) and failed revascularization (OR: 68, 95% CI 3.12-1489, p = 0.01) as the only significant predictors of unfavorable clinical outcome. Nonetheless, the likelihood of favorable clinical outcome was higher in patients with an ICA occlusion who were revascularized in < 2 vs. ≥ 2 (44 vs 4%, p = 0.01) or < 3 vs. ≥ 3 (32 vs. 0%, p = 0.02) passes.
Conclusion:
The likelihood of angiographic improvement in patients with ELVO significantly decreases after the second pass. A greater number of passes is associated with worsened clinical outcomes.
