When you enter the emergency room you'll have to demand your doctor accomplish the thrombectomy in one pass or they better have followup protocols that restore functionality to the same that would have occurred in one pass.
First pass effect in posterior circulation occlusions: Analysis from the CICAT registry
Abstract
Background:
The
first pass effect (FPE) is an independent predictor of functional
independence in patients with large vessel occlusion in anterior
circulation ischemic strokes. However, whether it predicts outcome in
posterior circulation large vessel occlusion (PC-LVO) is uncertain. We
aimed to study the frequency, characteristics, and predictors of FPE and
its association with clinical outcomes in PC-LVO.
Method:
We
performed an analysis from the prospective CICAT Registry. All patients
with PC-LVO who underwent endovascular therapy between January 2016 and
January 2020 were included. A centrally assessed clinical follow-up was
performed at 3 months by blinded investigators. FPE was defined as the
achievement of modified Thrombolysis In Cerebral Infarction 3 in a
single pass of the endovascular thrombectomy device, and multi-pass
effect (MPE) if it was achieved in more than one pass. A multivariable
analysis was performed to identify whether FPE is an independent
predictor of functional independence defined as a modified Rankin Score
of 0–2.
Results:
We
analyzed data from 265 patients in who FPE was achieved in 105 (39.6%).
Patients with FPE were more likely to achieve functional independence
compared to the non-FPE group (52.4% vs 25.1%, p < .001) and the MPE group (52.4% vs 26.7%, p
< .001). FPE was independently associated with functional
independence (adjusted odds ratio (aOR): 2.10, 95% confidence interval
(CI) 1.01-4.37) but MPE was not (aOR: 0.92, 95% CI 0.40-2.13).
Independent predictors of FPE were the use of direct aspiration, embolic
mechanism of stroke, and the absence of general anesthesia (GA) use.
Conclusions:
FPE
is an independent predictor of functional independence in PC-LVO and
was associated with a significantly better outcome than MPE.
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References
1. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 2007; 38(3): 967–973.
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