Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke-Reference-Cited by-同舟云学术

Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke

Published:2024-03-14 Issue: Volume: Page:
ISSN:0148-396X
Container-title:Neurosurgery
language:en
Short-container-title:

Author:

Koo Andrew B.¹^ORCID,Reeves Benjamin C.¹,Renedo Daniela¹,Maier Ilko L.²,Al Kasab Sami³,Jabbour Pascal⁴,Kim Joon-Tae⁵,Wolfe Stacey Q.⁶,Rai Ansaar⁷,Starke Robert M.⁸,Psychogios Marios-Nikos⁹,Shaban Amir¹⁰,Arthur Adam¹¹,Yoshimura Shinichi¹²,Cuellar Hugo¹³,Grossberg Jonathan A.¹⁴,Alawieh Ali¹⁴,Romano Daniele G.¹⁵,Tanweer Omar¹⁶,Mascitelli Justin¹⁷,Fragata Isabel¹⁸,Polifka Adam¹⁹,Osbun Joshua²⁰,Crosa Roberto²¹,Park Min S.²²,Levitt Michael R.²³,Brinjikji Waleed²⁴,Moss Mark²⁵,Dumont Travis²⁶,Williamson Richard²⁷,Navia Pedro²⁸,Kan Peter²⁹,Spiotta Alejandro M.³,Sheth Kevin N.³⁰,de Havenon Adam³⁰,Matouk Charles C.¹

Affiliation:

1. Department of Neurosurgery, Yale University, New Haven, Connecticut, USA;

2. Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany;

3. Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA;

4. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA;

5. Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea;

6. Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;

7. Department of Neuroradiology, West Virginia School of Medicine, Morgantown, West Virginia, USA;

8. Department of Neurosurgery, University of Miami Health System, Miami, Florida, USA;

9. Department of Diagnostic and Interventional Neuroradiology, University of Basel, Basel, Switzerland;

10. Department of Neurology, The University of Iowa, Iowa City, Iowa, USA;

11. Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, Tennessee, USA;

12. Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan;

13. Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA;

14. Department of Neurosurgery, Emory University, Atlanta, Georgia, USA;

15. Department of Radiology, Aou S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy;

16. Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA;

17. Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA;

18. Department of Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal;

19. Department of Neurosurgery, University of Florida, Gainesville, Florida, USA;

20. Department of Neurosurgery, Washington University, St. Louis, Missouri, USA;

21. Department of Neurosurgery, Medica Uruguaya, Montevideo, Uruguay;

22. Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA;

23. Department of Neurosurgery, University of Washington, Seattle, Washington, USA;

24. Department of Radiology, Mayo Clinic in Minnesota, Rochester, Minnesota, USA;

25. Department of Interventional Neuroradiology, Washington Regional Medical Center, Fayetteville, Arkansas, USA;

26. Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA;

27. Department of Neurosurgery, Allegheny Hospital, Pittsburgh, Pennsylvania, USA;

28. Department of Interventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain;

29. Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA;

30. Department of Neurology, Yale University, New Haven, Connecticut, USA

Abstract

BACKGROUND AND OBJECTIVES: First pass effect (FPE) is a metric increasingly used to determine the success of mechanical thrombectomy (MT) procedures. However, few studies have investigated whether the duration of the procedure can modify the clinical benefit of FPE. We sought to determine whether FPE after MT for anterior circulation large vessel occlusion acute ischemic stroke is modified by procedural time (PT). METHODS: A multicenter, international data set was retrospectively analyzed for anterior circulation large vessel occlusion acute ischemic stroke treated by MT who achieved excellent reperfusion (thrombolysis in cerebral infarction 2c/3). The primary outcome was good functional outcome defined by 90-day modified Rankin scale scores of 0–2. The primary study exposure was first pass success (FPS, 1 pass vs ≥2 passes) and the secondary exposure was PT. We fit-adjusted logistic regression models and used marginal effects to assess the interaction between PT (≤30 vs >30 minutes) and FPS, adjusting for potential confounders including time from stroke presentation. RESULTS: A total of 1310 patients had excellent reperfusion. These patients were divided into 2 cohorts based on PT: ≤30 minutes (777 patients, 59.3%) and >30 minutes (533 patients, 40.7%). Good functional outcome was observed in 658 patients (50.2%). The interaction term between FPS and PT was significant (P = .018). Individuals with FPS in ≤30 minutes had 11.5% higher adjusted predicted probability of good outcome compared with those who required ≥2 passes (58.2% vs 46.7%, P = .001). However, there was no significant difference in the adjusted predicted probability of good outcome in individuals with PT >30 minutes. This relationship appeared identical in models with PT treated as a continuous variable. CONCLUSION: FPE is modified by PT, with the added clinical benefit lost in longer procedures greater than 30 minutes. A comprehensive metric for MT procedures, namely, FPE30, may better represent the ideal of fast, complete reperfusion with a single pass of a thrombectomy device.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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