Abstract
Introduction
Although first pass effect (FPE) is used as a procedural metric in proximal large vessel occlusion stroke undergoing mechanical thrombectomy (MT), data in distal medium vessel occlusion (DMVO) is lacking. We aimed to investigate the predictors of FPE in DMVO undergoing MT and evaluate outcomes associated with FPE compared to non‐FPE.
Methods
Retrospective analysis of a prospectively collected database from 14 comprehensive stroke centers in the United States and Europe. Patients were included if they had isolated DMVO stroke due to MCA‐M3/M4, ACA‐A2/3 or PCA‐P1/2 segments and were treated with MT using stentriever, contact aspiration, or combination technique as first‐line therapy. Uni and multivariable analyses were used to identify factors associated with FPE (eTICI grade 2C or 3 after single device pass). Additionally, we evaluated the association of FPE with mRS0‐1, mRS0‐2, and mortality at 90 days.
Results
Among 345 patients included in the analysis, patients with FPE (n=102) had comparable median age (68 vs 70 years, P=0.20), baseline NIHSS score (11 vs. 11, P=0.59) and time form last known normal to puncture (307 vs 339 minutes, P=0.75), and rates of preprocedural IV‐thrombolysis (42.2% vs. 36.6%, P=0.34), general anesthesia (12.8% vs. 20.6%, P=0.09) and occlusion site compared to those with non‐FPE (n=243). Patients with FPE had higher frequency of balloon guide catheter (BGC) usage (40.2% vs. 20.6%, P<0.001) and shorter median procedure time (32 vs. 52 minutes, P<0.001) compared to those with non‐FPE. Otherwise, the demographic, clinical and procedural characteristics were similar among both groups (Table 1). In multivariable analysis, BGC (aOR2.30, 95%CI[1.31‐4.06], P=0.004) and hypertension (aOR2.29, 95%CI[1.14‐4.61, P=0.02) were the predictors of FPE. In terms of outcome, patients with FPE high lower median 24hrs NIHSS score (5 vs. 9, P=0.005) and a trend to less frequents rates of procedural complications (4% vs. 9.1%, aOR 0.35, 95%CI[0.11‐1.08], P=0.07). However, there was no significant differences in symptomatic intracerebral hemorrhage (sICH) (5% vs. 6%, aOR0.83, 95%CI[0.28‐2.45], P=0.74), 90‐day mRS0‐1 (38.5% vs. 32%, aOR1.54, 95%CI[0.89‐2.66], P=0.12), mRS0‐2 (51% vs. 45.5%, aOR1.31, 95%CI[0.76‐2.27], P=0.34) or mortality (23.9% vs. 23%, aOR1.02, 95%CI[0.55‐1.90], P=0.95) between FPE and non‐FPE groups.
Conclusions
In patients with DMVO undergoing MT, BGC was independently associated with FPE. FPE was not associated with clinical outcomes (rates of sICH, 90‐day mRS0‐1, 0‐2 and mortality). Further studies with larger cohort are warranted
Disclosure
M. Mohammaden: None. M. Dohiem: None. H. Abdelhamid: None. S. Matsoukas: None. B.R. Schuldt: None. J. Fifi: None. O. Kuybu: None. A.R. Al‐Bayati: None. M. Marta Olive‐Gadea: None. M. Rodrigo‐Gisbert: None. M. Requena: None. A. Monteiro: None. A. Siddiqui: None. S. Yu: None. J.E. Siegler: None. M. Farooqui: None. J. Vivanco‐Suarez: None. S. Ortega‐Gutierrez: None. C.M. Cortez: None. R. Hanel: None. A.E. Hassan: None. T. Nguyen: None. M. Abdalkader: None. P. Klein: None. M. Salem: None. J. Burkhardt: None. M. Colasurdo: None. P. Kan: None. M. Hafeez: None. O. Tanweer: None. S. Peng: None. A. Alaraj: None. R. Nogueira: None. D. Haussen: None.
