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True first-pass effect in patients undergoing thrombectomy for acute large core strokes
Shitao Fan1, Changwei Guo1, Jiacheng Huang1
1Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China.
Annals of Clinical and Translational Neurology
|August 2, 2024
Summary
Achieving true first-pass effect (T-FPE) in acute ischemic stroke (AIS) patients with large core infarcts significantly improves functional outcomes and reduces mortality after endovascular treatment (EVT). This real-world study highlights T-FPE as a critical factor for better patient recovery.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- The prognostic significance of true first-pass effect (T-FPE) in acute ischemic stroke (AIS) patients with large ischemic cores undergoing mechanical thrombectomy remains unclear.
- Extended thrombolysis achieving eTICI 3 after one thrombectomy pass defines T-FPE.
Purpose of the Study:
- To investigate the association between achieving T-FPE and patient outcomes in AIS with large core infarcts.
- To identify predictors of T-FPE and compare outcomes based on the number of thrombectomy passes.
Main Methods:
- A multicenter, prospective registry study included consecutive AIS patients with large core infarcts undergoing thrombectomy.
- Outcomes were compared between patients with and without T-FPE, and across different numbers of thrombectomy passes.
- Multivariate analysis identified predictors of T-FPE. Primary outcome: good functional outcome (modified Rankin Scale 0-3) at 90 days. Safety outcomes: 90-day mortality and symptomatic intracerebral hemorrhage.
Main Results:
- Among 447 patients, 22.8% achieved T-FPE.
- T-FPE was significantly associated with improved functional outcomes (OR 2.221; p < 0.001) and reduced 90-day mortality (31.4% vs. 45.5%; p = 0.012).
- Occlusion site and lower diastolic blood pressure were significant predictors of T-FPE.
Conclusions:
- True first-pass effect is associated with favorable 90-day outcomes in AIS patients with large ischemic cores undergoing endovascular therapy.
- Achieving T-FPE is a crucial goal in mechanical thrombectomy for large core infarcts.
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