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Updated: Sep 17, 2025
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An In vitro System to Gauge the Thrombolytic Efficacy of Histotripsy and a Lytic Drug
Published on: June 4, 2021
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Is first-pass effect a meaningful metric to evaluate thrombectomy technologies?
Arjun Agrawal1, Akash S Agrawal1, Jase L Howell1
1Department of Interventional Neuroradiology, Goodman Campbell Brain and Spine, Ascension St Vincent Hospital, Indianapolis, IN, USA.
Summary
First pass effect in stroke thrombectomy is not a reliable predictor of good clinical outcomes. Time to reperfusion, patient age, and successful recanalization are more significant factors for successful stroke treatment.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Successful reperfusion after a single pass during stroke thrombectomy, known as the first pass effect (FPE), is linked to good clinical outcomes.
- The clinical significance of FPE as a metric for evaluating thrombectomy effectiveness is uncertain, potentially being an epiphenomenon.
- This study investigates the association between FPE and favorable clinical outcomes in a large patient cohort.
Purpose of the Study:
- To retrospectively analyze a single-center database of mechanical thrombectomy procedures.
- To evaluate the association of the first pass effect (FPE) with good clinical outcomes (modified Rankin Scale 0-2 at 90 days).
- To identify key metrics beyond FPE that predict successful stroke treatment.
Main Methods:
- Retrospective analysis of 1047 consecutive mechanical thrombectomies (2011-2020).
- Inclusion criteria: patients aged 18+, 3-month clinical follow-up.
- Statistical analysis included univariate and multivariate models correlating demographics, time metrics (onset to recanalization, onset to puncture, puncture to recanalization), number of passes, and reperfusion grade (mTICI ≥ 2B) with 90-day mRS scores.
Main Results:
- Of 685 included patients, multivariate analysis identified onset to puncture (OTP), patient age, and successful reperfusion (mTICI ≥ 2B) as significantly associated with good clinical outcomes.
- Puncture to recanalization (PTR) time became significantly associated with good outcomes when the PTR to onset to recanalization (OTR) ratio was ≥ 3%.
- Time metrics were consistently associated with good outcomes, whereas the number of passes was not.
Conclusions:
- Time to reperfusion, patient age, and the degree of recanalization are critical factors for good clinical outcomes after stroke thrombectomy.
- The first pass effect (FPE) is not a reliable independent predictor of successful outcomes.
- Procedural timing and reperfusion success are more important metrics than the number of passes required for thrombectomy.
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