Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
J Neurointerv Surg. 2021 Jul;13(7):619-622. doi: 10.1136/neurintsurg-2020-016952. Epub 2021 Jan 21.
First pass effect (FPE), defined as near-total/total reperfusion of the territory (modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3) of the occluded artery after a single thrombectomy attempt (single pass), has been associated with superior safety and efficacy outcomes than in patients not experiencing FPE.
To characterize the clinical features, incidence, and predictors of FPE in the anterior and posterior circulation among patients enrolled in the Trevo Registry.
Data were analyzed from the Trevo Retriever Registry. Univariate and multivariable analyses were used to assess the relationship of patient (demographics, clinical, occlusion location, collateral grade, Alberta Stroke Program Early CT Score (ASPECTS)) and device/technique characteristics with FPE (mTICI 2c/3 after single pass).
FPE was achieved in 27.8% (378/1358) of patients undergoing anterior large vessel occlusion (LVO) thrombectomy. Multivariable regression analysis identified American Society of Interventional and Therapeutic Neuroradiology (ASITN) levels 2-4, higher ASPECTS, and presence of atrial fibrillation as independent predictors of FPE in anterior LVO thrombectomy. Rates of modified Rankin Scale (mRS) score 0-2 at 90 days were higher (63.9% vs 53.5%, p<0.0006), and 90-day mortality (11.4% vs 12.8%, p=0.49) was comparable in the FPE group and non-FPE group. Rate of FPE was 23.8% (19/80) among basilar artery occlusion strokes, and outcomes were similar between FPE and non-FPE groups (mRS score 0-2, 47.4% vs 52.5%, p=0.70; mortality 26.3% vs 18.0%, p=0.43). Notably, there were no difference in outcomes in FPE versus non-FPE mTICI 2c/3 patients.
Twenty-eight percent of patients undergoing anterior LVO thrombectomy and 24% of patients undergoing basilar artery occlusion thrombectomy experience FPE. Independent predictors of FPE in anterior circulation LVO thrombectomy include higher ASITN levels, higher ASPECTS, and the presence of atrial fibrillation.
首次通过效应（FPE）定义为闭塞动脉单次取栓尝试后（单次通过）闭塞区域的近乎完全/完全再灌注（改良脑梗死溶栓（mTICI）2c/3），与未发生 FPE 的患者相比，具有更好的安全性和疗效结果。
描述 Trevo 登记研究中前循环和后循环患者的临床特征、发生率和 FPE 的预测因素。
分析来自 Trevo 取栓器登记研究的数据。使用单变量和多变量分析评估患者（人口统计学、临床、闭塞部位、侧支分级、阿尔伯塔卒中项目早期 CT 评分（ASPECTS））和设备/技术特征与 FPE（单次通过后 mTICI 2c/3）之间的关系。
在前循环大血管闭塞（LVO）取栓术中，27.8%（378/1358）的患者实现了 FPE。多变量回归分析确定美国介入治疗和治疗神经放射学会（ASITN）分级 2-4、较高的 ASPECTS 和存在心房颤动是前循环 LVO 取栓术 FPE 的独立预测因素。90 天时改良 Rankin 量表（mRS）评分 0-2 的比例更高（63.9% vs 53.5%，p<0.0006），FPE 组和非 FPE 组 90 天死亡率（11.4% vs 12.8%，p=0.49）相当。基底动脉闭塞卒中患者中 FPE 发生率为 23.8%（19/80），FPE 组和非 FPE 组的结果相似（mRS 评分 0-2，47.4% vs 52.5%，p=0.70；死亡率 26.3% vs 18.0%，p=0.43）。值得注意的是，FPE 与非 FPE 的 mTICI 2c/3 患者在结局方面没有差异。
前循环 LVO 取栓术中 28%的患者和基底动脉闭塞取栓术中 24%的患者出现 FPE。前循环 LVO 取栓术中 FPE 的独立预测因素包括较高的 ASITN 分级、较高的 ASPECTS 和心房颤动的存在。
