Incidence and potential predictors of first pass effect within 30 min of groin puncture: An exploratory single-center
Tshibambe Nathanael Tshimbombu1, Shashvat Desai2, Yaswanth Chintaluru3
1Department of Neurology, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Abstract:
Background and PurposeThe first pass effect (FPE), achieving near-complete revascularization in a single pass, predicts good outcomes in mechanical thrombectomy (MT). FPE30, achieving FPE within 30 min of groin puncture, is a novel procedural metric proposed as an indicator of maximal procedural and systems-level efficiency. This study aimed to determine the incidence of FPE30 and explore potential predictors in a real-world clinical setting, thereby assessing its utility as a performance benchmark.MethodsWe retrospectively analyzed 274 consecutive MT patients at a comprehensive stroke center. The primary outcome was FPE30, defined as achieving mTICI 2c-3 in a single pass within 30 min of groin puncture. Patient characteristics were compared between FPE30 and FPE > 30 groups.ResultsOf 274 patients, 52 (19.0%) achieved FPE; 43 (82.7%) met the FPE30 benchmark. No statistically significant predictors of FPE30 were found. Trends indicated FPE30 was less common in internal carotid artery (ICA) terminus occlusions (7.0% vs. 33.3%; P = .09) and more frequent with radial access (48.8% vs. 33.3%; P = .40). There was no significant difference in good 90-day functional outcomes (mRS 0-2) between FPE30 (34.9%) and FPE > 30 (33.3%) groups (P > .99).ConclusionsAchieving FPE within 30 min was common in this cohort, but not significantly predicted by measured factors. The lack of an association between FPE30 and improved 90-day functional outcomes suggests that the primary benefit is derived from achieving FPE itself, regardless of whether it is accomplished within or just beyond this ultra-early timeframe. Trends suggest occlusion location and access site may affect reperfusion speed. Lack of functional benefit difference highlights that FPE achievement itself remains the key outcome determinant. These findings are hypothesis-generating and warrant larger studies to clarify the value and predictors of FPE30 as both a clinical prognosticator and a quality improvement metric.
Insights
First pass effect within 30 minutes (FPE30) is common in mechanical thrombectomy but has no identified predictors. Achieving FPE itself, not the speed, is key for good patient outcomes.
Area of Science:
- Neurology
- Interventional Radiology
- Stroke Medicine
Background:
- The first pass effect (FPE) in mechanical thrombectomy (MT) is crucial for good patient outcomes.
- FPE30, defined as achieving FPE within 30 minutes of groin puncture, is a novel metric for procedural efficiency.
Purpose of the Study:
- To determine the incidence of FPE30 in a real-world setting.
- To identify potential predictors of FPE30.
- To assess FPE30's utility as a performance benchmark in MT.
Main Methods:
- Retrospective analysis of 274 consecutive MT patients.
- Primary outcome: FPE30 (mTICI 2c-3 in a single pass within 30 minutes).
- Comparison of patient characteristics between FPE30 and FPE > 30 groups.
Main Results:
- 43 out of 274 patients (19.0%) achieved FPE; 82.7% of those met the FPE30 benchmark.
- No statistically significant predictors for FPE30 were identified.
- Trends suggested lower FPE30 incidence in internal carotid artery terminus occlusions and higher incidence with radial access. No significant difference in 90-day functional outcomes between FPE30 and FPE > 30 groups.
Conclusions:
- FPE30 was common but lacked significant predictors in this cohort.
- The primary benefit for patient outcomes stems from achieving FPE, irrespective of the time frame (within or slightly beyond 30 minutes).
- Further research with larger studies is needed to clarify the value and predictors of FPE30 as a clinical prognosticator and quality improvement metric.
