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Updated: Jun 27, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Impact of device pass count and reperfusion levels in anterior circulation stroke: differential effects based on
Luca Meucci1, Lukas Meyer2, Gabriel Broocks3
1Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. l.meucci@uke.de.
Insights
Achieving successful reperfusion with endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) is key. Single-pass mTICI 3 reperfusion offers the best functional independence, while mTICI 2b with additional passes also improves outcomes.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Medicine
Background:
- Endovascular thrombectomy (EVT) is a critical treatment for acute ischemic stroke (AIS).
- The relationship between reperfusion success, device passes, and patient outcomes requires further investigation.
- Optimizing EVT strategies is essential for improving functional independence in stroke survivors.
Purpose of the Study:
- To assess the impact of different reperfusion levels and device pass counts on functional outcomes in AIS patients undergoing EVT.
- To analyze large-scale, multicenter registry data to determine the optimal number of passes and reperfusion grade for EVT.
- To identify predictors of functional independence following EVT for anterior circulation AIS.
Main Methods:
- A prospective, multicenter German Stroke Registry cohort (06/2015-12/2023) was analyzed.
- Inclusion criteria included anterior circulation AIS, pre-stroke modified Rankin Scale (mRS) 0-1, and at least one device pass.
- Functional independence at 90 days was the primary outcome, evaluated using Inverse Probability Regression Adjustment.
Main Results:
- Single-pass mTICI 3 reperfusion was associated with the highest functional independence rate (54.3%) and lowest mortality (19.6%) at 90 days.
- Achieving mTICI 2b reperfusion with an additional pass (n+1) showed significantly better outcomes than mTICI 0-2a with fewer passes (n).
- No significant difference in 90-day functional independence was found between mTICI 2b achieved in n passes and mTICI 3 achieved in n+1 passes.
Conclusions:
- Single-pass mTICI 3 reperfusion yields the best functional independence rates in AIS patients treated with EVT.
- Utilizing up to three passes to achieve mTICI 2b reperfusion improves outcomes compared to lower reperfusion grades.
- Further improvement from mTICI 2b to mTICI 3 reperfusion did not significantly enhance functional independence at 90 days.
Background:
The relationship between angiographic success, number of device passes and functional outcome is a topic of clinical interest in endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). This study systematically assessed differential effects of reperfusion levels and device pass counts based on large-scale, multicenter registry data.
Methods:
Patients enrolled in the prospective, multicenter German Stroke Registry between 06/2015-12/2023 were screened. Inclusion criteria were anterior circulation AIS, pre-stroke mRS of 0-1, ≥ 1 passes and availability of clinical data. The primary outcome was functional independence at 90 days. Outcomes were evaluated across different degrees of reperfusion and number of passes employing Inverse Probability Regression Adjustment to control for confounding factors.
Results:
6,398 patients fulfilled the inclusion criteria. Single-pass mTICI 3 reperfusion was associated with the highest estimated rate of functional independence (54.3% [95% CI: 52.1-56.4]; p < 0.01) and the lowest mortality (19.6% [95% CI: 18.3-20.9]; p < 0.01) at 90 days. Up to three passes, mTICI 2b reperfusion achieved with n + 1 passes was associated with significantly better outcomes compared to mTICI 0-2a achieved with n passes. No significant difference in 90-day functional independence was observed between n pass mTICI 2b and n + 1 pass mTICI 3.
Conclusions:
The highest rate of functional independence at 90 days was observed for single-pass mTICI 3 reperfusion. Up to three passes, achieving mTICI 2b with one additional pass was associated with improved outcomes compared to lower reperfusion grades. Improvement from mTICI 2b to 3 did not significantly increase outcomes.
