First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study-Reference-Cited by-同舟云学术

First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study

Published:2023-10-27 Issue: Volume: Page:
ISSN:2396-9873
Container-title:European Stroke Journal
language:en
Short-container-title:European Stroke Journal

Author:

Radu Răzvan Alexandru¹^ORCID,Costalat Vincent¹,Fahed Robert²^ORCID,Ghozy Sherief³,Siegler James E⁴,Shaikh Hamza⁴,Khalife Jane⁴,Abdalkader Mohamad⁵,Klein Piers⁵^ORCID,Nguyen Thanh N⁵^ORCID,Heit Jeremy J⁶^ORCID,Sweid Ahmad³,El Naamani Kareem⁷,Regenhardt Robert W⁸,Diestro Jose Danilo Bengzon⁹,Cancelliere Nicole M⁹,Amllay Abdelaziz⁷,Meyer Lukas¹⁰,Dusart Anne¹¹,Bellante Flavio¹¹^ORCID,Forestier Géraud¹²^ORCID,Rouchaud Aymeric¹²,Saleme Suzana¹²,Mounayer Charbel¹²,Fiehler Jens¹⁰,Kühn Anna Luisa¹³^ORCID,Puri Ajit S¹³,Dyzmann Christian¹⁴,Kan Peter T¹⁵,Colasurdo Marco¹⁵,Marnat Gaultier¹⁶^ORCID,Berge Jérôme¹⁶,Barreau Xavier¹⁶,Sibon Igor¹⁷,Nedelcu Simona¹⁸,Henninger Nils¹⁸¹⁹,Kyheng Maéva²⁰,Marotta Thomas R⁹,Stapleton Christopher J⁸,Rabinov James D⁸,Ota Takahiro²¹^ORCID,Dofuku Shogo²¹^ORCID,Yeo Leonard LL²²^ORCID,Tan Benjamin YQ²²²³,Martinez-Gutierrez Juan Carlos²⁴,Salazar-Marioni Sergio²⁴^ORCID,Sheth Sunil²⁴,Renieri Leonardo²⁵,Capirossi Carolina²⁵,Mowla Ashkan²⁶,Tjoumakaris Stavropoula I⁷,Jabbour Pascal⁷^ORCID,Khandelwal Priyank²⁷,Biswas Arundhati²⁸,Clarençon Frédéric²⁹,Elhorany Mahmoud²⁹³⁰,Premat Kevin²⁹,Valente Iacopo³¹,Pedicelli Alessandro³¹,Pedro Filipe João³²,Varela Ricardo³³,Quintero-Consuegra Miguel³⁴,Gonzalez Nestor R³⁴^ORCID,Möhlenbruch Markus A³⁵^ORCID,Jesser Jessica³⁵^ORCID,Tancredi Illario³⁶,ter Schiphorst Adrien³⁷,Yedavalli Vivek³⁸,Harker Pablo³⁹,Chervak Lina M³⁹,Aziz Yasmin³⁹^ORCID,Gory Benjamin⁴⁰,Paul Stracke Christian⁴¹,Hecker Constantin⁴²,Killer-Oberpfalzer Monika⁴²,Griessenauer Christoph J⁴²,Thomas Ajith J⁴,Hsieh Cheng-Yang⁴³,Liebeskind David S⁴⁴,Alexandre Andrea M³¹,Faizy Tobias D¹⁰^ORCID,Weyland Charlotte³⁵,Patel Aman B⁸,Pereira Vitor Mendes⁹,Lubicz Boris⁴⁵,Dmytriw Adam A⁸⁹,Guenego Adrien⁴⁵

Affiliation:

1. Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France

2. Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada

3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

4. Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA

5. Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA

6. Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA

7. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

8. Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA

9. Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada

10. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

11. Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium

12. University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France

13. Department of Radiology, University of Massachusetts Memorial Hospital, Worcester, MA, USA

14. Department of Diagnostic and Interventional Radiology and Neuroradiology, Sana Klinik Lübeck, Lübeck, Germany

15. Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA

16. Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France

17. Neurology Department, Bordeaux University Hospital, Bordeaux, France

18. Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA

19. Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA

20. Department of Biostatistics, CHU Lille, Lille, France

21. Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

22. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

23. Division of Neurology, Department of Medicine, National University Hospital, Singapore

24. Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA

25. Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy

26. Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA

27. Department of Endovascular Neurosurgery and Neuroradiology, NJMS, Newark, NJ, USA

28. Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA

29. Department of Neuroradiology, Pitié-Salpêtrière Hospital. Paris. France; GRC BioFast, Sorbonne University, Paris VI, France

30. Neurology Department, Faculty of Medicine, Tanta University, Egypt

31. UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy

32. Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal

33. Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal

34. Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

35. Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany

36. Department of Radiology, Hôpital Civil Marie Curie, Charleroi, Belgium

37. Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France

38. Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA

39. Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA

40. Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France

41. Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Münster, Germany

42. Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria

43. Neurology Department, Sin-Lau Hospital, Tainan

44. UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, CA, USA

45. Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium

Abstract

Introduction: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. Patients and Methods: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0–2 at 3 months. Results: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10–2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93–0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59–3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25–0.72) and 0.55 (95% CI, 0.39–0.77), respectively. Conclusion: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical)

Link

http://journals.sagepub.com/doi/pdf/10.1177/23969873231208276

Reference36 articles.

1. First Pass Effect

2. When to Stop

3. Influence of first-pass effect on recanalization outcomes in the era of mechanical thrombectomy: a systemic review and meta-analysis

4. Factors Influencing Recanalization After Mechanical Thrombectomy With First-Pass Effect for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis