Kobeissi Hassan, Adusumilli Gautam, Ghozy Sherief, Dmytriw Adam A, Senol Yigit Can, Orscelik Atakan, Bilgin Cem, Kadirvel Ramanathan, Brinjikji Waleed, Kallmes David F
Department of Radiology, Mayo Clinic, Rochester, MN, USA; College of Medicine, Central Michigan University, Mount Pleasant, MI, USA.
Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
J Stroke Cerebrovasc Dis. 2023 Oct;32(10):107304. doi: 10.1016/j.jstrokecerebrovasdis.2023.107304. Epub 2023 Aug 12.
First-pass effect (FPE) has been shown to be a predictor of favorable clinical outcomes following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) in the anterior circulation. Literature regarding FPE for posterior circulation AIS is sparse; we conducted a systematic review and meta-analysis to explore FPE in posterior circulation stroke undergoing EVT.
We conducted a systematic review of the English literature in PubMed, Embase, Scopus, and Web of Science. FPE was defined as thrombolysis in cerebral infarction (TICI) 2c-3 and modified FPE (mFPE) was defined as TICI 2b-3 in one pass. Definitions of non-FPE and non-mFPE varied among studies. The primary outcome of interest was modified Rankin Scale (mRS) 0-2. Secondary outcomes of interest were mRS 0-3, symptomatic intracranial hemorrhage (sICH), and mortality. We calculated odds ratios (OR) and corresponding 95% confidence intervals (CI). Heterogeneity was assessed with Q statistic and I test.
Seven studies with 417 patients in the mFPE group, 942 in the non-mFPE group, 545 in the FPE group, and 1023 in the non-FPE group were included. Overall, FPE was associated with greater rates of 90-day mRS 0-2 (OR= 2.78, 95% CI= 2.11-3.65; P-value< 0.001) and mRS 0-3 (OR= 2.67, 95% CI= 1.98-3.60; P-value< 0.001); however, there was significant heterogeneity among studies for both mRS 0-2 (I= 69%; P-value< 0.001) and mRS 0-3 (I= 69%; P-value< 0.001). FPE and non-FPE were associated with similar rates of sICH (OR= 0.65, 95% CI= 0.40-1.07; P-value= 0.09), and no heterogeneity was observed (I= 0%; P-value= 0.95). FPE was associated with lower rates of mortality (OR= 0.44, 95% CI= 0.33-0.58; P-value< 0.001), although heterogeneity was observed (I= 58%; P-value= 0.01).
FPE is associated with favorable clinical outcomes in patients undergoing EVT for posterior circulation AIS. Future studies should work to further quantify the impact of FPE on outcomes in the posterior circulation.
首次通过效应（FPE）已被证明是前循环急性缺血性卒中（AIS）血管内血栓切除术（EVT）后良好临床结局的预测指标。关于后循环AIS的FPE的文献较少；我们进行了一项系统评价和荟萃分析，以探讨接受EVT的后循环卒中的FPE。
我们对PubMed、Embase、Scopus和Web of Science中的英文文献进行了系统评价。FPE定义为脑梗死溶栓（TICI）2c - 3级，改良FPE（mFPE）定义为一次通过时TICI 2b - 3级。不同研究中对非FPE和非mFPE的定义有所不同。感兴趣的主要结局是改良Rankin量表（mRS）0 - 2级。感兴趣的次要结局是mRS 0 - 3级、症状性颅内出血（sICH）和死亡率。我们计算了比值比（OR）和相应的95%置信区间（CI）。采用Q统计量和I²检验评估异质性。
纳入了7项研究，mFPE组有417例患者，非mFPE组有942例，FPE组有545例，非FPE组有1023例。总体而言，FPE与90天mRS 0 - 2级（OR = 2.78，95%CI = 2.11 - 3.65；P值<0.001）和mRS 0 - 3级（OR = 2.67，95%CI = 1.98 - 3.60；P值<0.001）的发生率较高相关；然而，对于mRS 0 - 2级（I² = 69%；P值<0.001）和mRS 0 - 3级（I² = 69%；P值<0.001），研究间存在显著异质性。FPE和非FPE与sICH的发生率相似（OR = 0.65，95%CI = 0.40 - 1.07；P值 = 0.09），未观察到异质性（I² = 0%；P值 = 0.95）。FPE与较低的死亡率相关（OR = 0.44，95%CI = 0.33 - 0.58；P值<0.001），尽管观察到异质性（I² = 58%；P值 = 0.01）。
FPE与接受EVT治疗后循环AIS的患者的良好临床结局相关。未来的研究应致力于进一步量化FPE对后循环结局的影响。
