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

Ameer E Hassan1, Mahmoud Dibas1,2, Amrou Sarraj3

  • 1Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center - Harlingen, TX, USA.

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|August 31, 2021
PubMed
Summary

Achieving first pass effect (FPE) reperfusion in stroke patients leads to better outcomes and higher functional independence. No significant difference was found between single-pass mTICI 2b and multiple-pass mTICI 3 reperfusion.

Keywords:
First passrecanalizationstrokethrombectomy

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Area of Science:

  • Neurology
  • Interventional Radiology
  • Cardiovascular Medicine

Background:

  • First pass effect (FPE) in mechanical thrombectomy aims for rapid reperfusion.
  • Achieving modified treatment in cerebral infarction (mTICI) grade 2c/3 on the first pass is linked to improved patient outcomes.
  • Understanding FPE's impact is crucial for optimizing stroke treatment strategies.

Purpose of the Study:

  • To compare outcomes between patients achieving FPE and those who do not.
  • To evaluate the efficacy of first-pass mTICI 2b versus multiple-pass mTICI 3 reperfusion.
  • To analyze the impact of FPE on discharge rates, functional independence, and mortality.

Main Methods:

  • Retrospective cohort study of 637 acute ischemic stroke patients undergoing mechanical thrombectomy.
  • Propensity-score matching used to create comparable groups for FPE vs. non-FPE and first-pass mTICI 2b vs. multiple-pass mTICI 3.
  • Comparison of baseline characteristics and outcomes including functional independence (modified Rankin Scale ≤2), mortality, and hemorrhage rates.

Main Results:

  • The FPE group showed significantly higher rates of discharge (33.6% vs. 19.4%) and 90-day functional independence (51.7% vs. 40.8%) compared to non-FPE.
  • FPE was associated with significantly lower mortality rates (18.0% vs. 27.5%).
  • No significant differences in outcomes were observed between first-pass mTICI 2b and multiple-pass mTICI 3 reperfusion.

Conclusions:

  • First-pass mTICI 2c/3 reperfusion is associated with improved safety and functional independence in stroke patients.
  • The study did not find significant outcome differences between first-pass mTICI 2b and multiple-pass mTICI 3.
  • Further large-scale studies are needed to definitively compare first-pass mTICI 2b and multiple-pass mTICI 3 outcomes.