Complete Sudden Recanalization: There Is Hope Beyond the First Pass Effect

Area of Science:

• Neurology
• Interventional Radiology
• Cardiovascular Diseases

Background:

• Endovascular treatment aims for rapid, complete recanalization in stroke patients.
• The pattern of recanalization per pass is crucial for procedural success.

Purpose of the Study:

• To investigate the impact of per-pass recanalization patterns on outcomes in patients with final complete recanalization.
• To determine if complete sudden recanalization (cSR) is associated with improved functional outcomes.

Main Methods:

• Retrospective analysis of 400 patients with internal carotid artery or M1-middle cerebral artery occlusion treated endovascularly.
• Defined complete sudden recanalization (cSR) as achieving expanded thrombolysis in cerebral infarction (eTICI) 2c-3 in a single pass.
• Compared outcomes between cSR and complete progressive recanalization groups.

Main Results:

• 75% of patients (301/400) achieved cSR.
• The cSR group had fewer passes (1 vs. 2) and shorter times to recanalization (27 vs. 46 minutes).
• cSR was an independent predictor of good functional outcome at 90 days (57.8% vs. 44.4%, aOR 1.72).

Conclusions:

• Complete sudden recanalization (cSR) is a significant predictor of favorable outcomes in stroke patients with large vessel occlusion.
• The positive impact of cSR on outcomes is independent of the total number of thrombectomy passes required.