Chen Chu, Zhang Tangqin, Xu Youqing, Xu Xiangjun, Xu Junfeng, Yang Ke, Yuan Lili, Yang Qian, Huang Xianjun, Zhou Zhiming
Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, China.
Front Neurol. 2022 Mar 25;13:664140. doi: 10.3389/fneur.2022.664140. eCollection 2022.
Successful recanalization after the first pass of the device in endovascular thrombectomy (EVT) can significantly improve patients' prognosis. We aimed to investigate the possible factors that influence achieving the first-pass effect (FPE).
We retrospectively analyzed the patients who underwent EVT caused by anterior circulation large vessel occlusion stroke (ALVOS) in our center. The FPE was defined as a successful recanalization [modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 defined as modified FPE (mFPE); mTICI 3 as true FPE (tFPE)] after one pass of the device without rescue therapy. Univariate and multivariate regression analyses were used to explore the predictors of FPE and the relationship between FPE and prognosis.
There were 278 patients (age, 69.3 ± 10.9 years, male, 51.1%) included, 30.2% of them achieved mFPE, while 21.2% achieved tFPE. We found the higher clot burden score (CBS), the truncal-type occlusion, and the favorable anatomy of both extracranial and intracranial segments of the internal carotid artery (ICA) were associated with achieving mFPE. The higher CBS and truncal-type occlusion were statistically significant predictors of tFPE. Moreover, FPE was significantly associated with improved clinical outcomes, regardless of mFPE and tFPE.
The CBS, tortuosity of ICA, and angiographic occlusion type were independent predictors of achieving FPE. The rate of improved clinical and safety outcomes was higher in patients with FPE, which has important clinical significance.
在血管内血栓切除术（EVT）中，设备首次通过时成功再通可显著改善患者预后。我们旨在研究影响实现首次通过效应（FPE）的可能因素。
我们回顾性分析了在本中心接受因前循环大血管闭塞性卒中（ALVOS）而行EVT的患者。FPE定义为设备单次通过且无需补救治疗的成功再通[改良脑梗死溶栓（mTICI）2b/3定义为改良FPE（mFPE）；mTICI 3定义为真正FPE（tFPE）]。采用单因素和多因素回归分析来探索FPE的预测因素以及FPE与预后之间的关系。
共纳入278例患者（年龄69.3±10.9岁，男性占51.1%），其中30.2%实现了mFPE，21.2%实现了tFPE。我们发现较高的血栓负荷评分（CBS）、主干型闭塞以及颈内动脉（ICA）颅外段和颅内段均具有良好的解剖结构与实现mFPE相关。较高的CBS和主干型闭塞是tFPE的统计学显著预测因素。此外，无论mFPE还是tFPE，FPE均与改善的临床结局显著相关。
CBS、ICA的迂曲程度和血管造影闭塞类型是实现FPE的独立预测因素。FPE患者的临床和安全性改善结局发生率更高，具有重要的临床意义。
