Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA.
Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
J Neurointerv Surg. 2019 Nov;11(11):1095-1099. doi: 10.1136/neurintsurg-2019-014773. Epub 2019 May 2.
The first pass effect has been recently reported as a predictor of good clinical outcome after stroke thrombectomy. We evaluate the first pass effect on outcome and the influence of revascularization in these and other patients.
We performed a retrospective analysis of a prospectively maintained database on anterior cerebral circulation stroke thrombectomy cases from April 2012 to April 2018. Data compiled included patient demographics, presenting National Institutes of Health Stroke Scale score, vessel occlusion site, thrombectomy procedural details, and 90 day modified Rankin Scale scores.
205 patients were included. The numbers of patients who underwent one, two, three, four, five, and six passes were 69, 70, 55, 9, 1, and 1, respectively. Successful revascularization was achieved in 87%, 83%, and 64% of patients in the one, two, and 3 or more passes groups, respectively (p=0.002). Good functional outcome was inversely correlated with number of passes when comparing the one, two, and three or more passes groups (54%, 43%, 29%; P=0.014). In patients with full revascularization, there was no significant difference in good functional outcomes between the one, two, and three or more passes groups (64%, 65%, 50%; P=0.432). Number of passes was not an independent negative predictor of good clinical outcome (OR 1.66, 95% CI 0.82 to 3.39; P=0.165).
First pass thrombectomy patients have better functional outcomes compared with beyond-first pass patients. This effect is related at least in part to a higher rate of revascularization in one pass patients. Revascularization beyond the first pass should continue to be the goal of stroke thrombectomy.
首次通过效应最近被报道为卒中取栓后良好临床结局的预测因素。我们评估了首次通过效应对结局的影响，以及在这些患者和其他患者中血管再通的影响。
我们对 2012 年 4 月至 2018 年 4 月期间前循环卒中取栓病例的前瞻性维护数据库进行了回顾性分析。收集的数据包括患者人口统计学资料、就诊时美国国立卫生研究院卒中量表评分、血管闭塞部位、取栓术细节和 90 天改良 Rankin 量表评分。
共纳入 205 例患者。行 1 次、2 次、3 次、4 次、5 次和 6 次取栓的患者分别为 69、70、55、9、1 和 1 例。1 次、2 次和 3 次或更多次取栓组的血管再通成功率分别为 87%、83%和 64%（p=0.002）。比较 1 次、2 次和 3 次或更多次取栓组，良好的功能结局与取栓次数呈负相关（54%、43%、29%；P=0.014）。在完全血管再通的患者中，1 次、2 次和 3 次或更多次取栓组的良好功能结局无显著差异（64%、65%、50%；P=0.432）。取栓次数不是良好临床结局的独立负预测因素（OR 1.66，95%CI 0.82 至 3.39；P=0.165）。
首次通过取栓患者的功能结局优于超过首次通过取栓患者。这种效应至少部分与首次通过取栓患者的血管再通率较高有关。血管再通应继续作为卒中取栓的目标。
