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Association Between Distal Stent Retriever Deployment Distance and First-Pass Effect and Hemorrhagic Complications in
Koji Yoshida1, Yosuke Akamatsu2, Hiromu Sasaki2
1From the Department of Neurosurgery (K.Y., H.S., K.D., M.Y., D.O., S.I., T.T., T.C., Y.O., T.M., H.K.), Hachinohe Red-Cross Hospital, Hachinohe, Aomori, Japan and Department of Neurosurgery (Y.A., M.Y., S.I., T.T., Y.O., T.M., K.O.), Iwate Medical School of Medicine, Yahaba-cho, Iwate, Japan. koyoshi@iwate-med.ac.jp.
AJNR. American Journal of Neuroradiology
|May 7, 2026
Summary
Longer stent retriever distance (SRD) is linked to higher first-pass effect (FPE) rates in stroke thrombectomy. However, increased device passes correlate with post-thrombectomy hemorrhage, not SRD.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Treatment
Background:
- Stent retrievers (SR) are crucial for mechanical thrombectomy in acute ischemic stroke.
- The relationship between SR positioning and treatment outcomes, specifically first-pass effect (FPE) and intracranial hemorrhage, requires further elucidation.
Purpose of the Study:
- To investigate the association between stent retriever distance (SRD) and modified first-pass effect (mFPE).
- To determine the relationship between SRD, mFPE, and post-thrombectomy symptomatic intracranial hemorrhage (sICH) in patients with middle cerebral artery (MCA) occlusions.
Main Methods:
- Retrospective analysis of 43 patients with MCA occlusions (M1 or M2 segments) treated with Solitaire X SR.
- Co-primary endpoints: mFPE and post-thrombectomy SAH.
- Multivariable logistic regression analysis to identify predictors of mFPE and post-thrombectomy SAH.
Main Results:
- Longer SRD was independently associated with achieving mFPE (OR per 1-mm increase, 1.27; P = .02).
- Patients achieving mFPE required fewer device passes (median 1 vs 2; P < .001).
- Increased device passes, not SRD, were independently associated with post-thrombectomy SAH (OR, 4.9; P = .01).
Conclusions:
- Longer SRD is associated with a higher likelihood of achieving mFPE in MCA occlusions.
- Repeated device passes during thrombectomy are independently associated with post-thrombectomy SAH.
- Findings suggest SR positioning impacts FPE, while procedural complexity influences hemorrhage risk.
