http://stroke.ahajournals.org/content/early/2018/02/16/STROKEAHA.117.020315
Abstract
Background and Purpose—In
acute ischemic stroke, fast and complete recanalization of the occluded
vessel is associated with improved outcomes. We describe a novel
measure for newer generation devices: the first pass effect (FPE). FPE
is defined as achieving a complete recanalization with a single
thrombectomy device pass.
Methods—The
North American Solitaire Acute Stroke Registry database was used to
identify a FPE subgroup. Their baseline features and clinical outcomes
were compared with non-FPE patients. Clinical outcome measures included
90-days modified Rankin Scale score, National Institutes of Health
Stroke Scale score, mortality, and symptomatic intracranial hemorrhage.
Multivariate analyses were performed to determine whether FPE
independently resulted in improved outcomes and to identify predictors
of FPE.
Results—A
total of 354 acute ischemic stroke patients underwent thrombectomy in
the North American Solitaire Acute Stroke registry. FPE was achieved in
89 out of 354 (25.1%). More middle cerebral artery occlusions (64%
versus 52.5%) and fewer internal carotid artery occlusions (10.1% versus
27.7%) were present in the FPE group. Balloon guide catheters were used
more frequently with FPE (64.0% versus 34.7%). Median time to
revascularization was significantly faster in the FPE group (median 34
versus 60 minutes; P=0.0003). FPE was an independent predictor
of good clinical outcome (modified Rankin Scale score ≤2 was seen in
61.3% in FPE versus 35.3% in non-FPE cohort; P=0.013; odds
ratio, 1.7; 95% confidence interval, 1.1–2.7). The independent
predictors of achieving FPE were use of balloon guide catheters and
non-internal carotid artery terminus occlusion.
Conclusions—The
achievement of complete revascularization from a single Solitaire
thrombectomy device pass (FPE) is associated with significantly higher
rates of good clinical outcome. The FPE is more frequently associated
with the use of balloon guide catheters and less likely to be achieved
with internal carotid artery terminus occlusion.
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