Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China.
Ann Clin Transl Neurol. 2024 Sep;11(9):2406-2416. doi: 10.1002/acn3.52155. Epub 2024 Aug 2.
The impact of true first-pass effect (T-FPE, achieving substantial recanalization with extended thrombolysis in cerebral infarction; eTICI 3 after 1 thrombectomy) and outcomes on acute ischemic stroke (AIS) with large ischemic core remains uncertain. We aimed to study the association between T-FPE and outcomes in AIS patients with large core infarct through a real-world multicenter study.
From a prospective multicentric registry, we collected the data of all consecutive acute stroke patients with a large ischemic core who underwent thrombectomy and compared the outcomes of patients who achieved T-FPE and those who did not. In addition, we compared the outcomes of patients with different numbers of thrombectomy pass to identify the effectiveness of T-FPE. Multivariate analysis was performed to determine the predictors of T-FPE. The primary outcome was good functional outcome (modified Rankin Scale score; mRS 0-3) at 90 days. Safety outcomes included a 90-day mortality and symptomatic intracerebral hemorrhage within 48 hours after thrombectomy.
Between November 2021 and February 2023, 447 eligible patients at 38 stroke centers were enrolled. Out of 447 thrombectomy patients, T-FPE was achieved in 102 individuals (22.8%). T-FPE was significantly associated with a higher proportion of good functional outcome (mRS 0-3 at 3 months, OR 2.221, 95% CI 1.418-3.479, p < 0.001) and lower mortality than non-T-FPE patients (31.4% vs. 45.5%, p = 0.012). The occlusion sites and lower DBP were strong predictors of T-FPE.
T-FPE was associated with favorable outcomes at 90 days in AIS patients with a large ischemic core who underwent EVT.
真正的首次通过效应（T-FPE，通过延长溶栓实现脑梗死的实质性再通；血栓切除术后 eTICI 3）对大梗死核心的急性缺血性脑卒中（AIS）的影响及其结果仍不确定。我们旨在通过一项真实世界的多中心研究，研究 T-FPE 与大核心梗死 AIS 患者结果之间的关系。
我们从一项前瞻性多中心登记处收集了所有接受血栓切除术的大缺血核心急性卒中患者的数据，并比较了达到 T-FPE 和未达到 T-FPE 的患者的结果。此外，我们比较了不同数量的血栓切除术通过以确定 T-FPE 的有效性。进行多变量分析以确定 T-FPE 的预测因素。主要结果是 90 天的良好功能结局（改良 Rankin 量表评分；mRS 0-3）。安全性结局包括血栓切除术后 90 天死亡率和 48 小时内症状性颅内出血。
2021 年 11 月至 2023 年 2 月期间，38 个卒中中心的 447 名符合条件的患者入组。在 447 名接受血栓切除术的患者中，有 102 人（22.8%）达到了 T-FPE。T-FPE 与更高比例的良好功能结局（3 个月时 mRS 0-3，OR 2.221，95%CI 1.418-3.479，p<0.001）和低于非 T-FPE 患者的死亡率显著相关（31.4% vs. 45.5%，p=0.012）。闭塞部位和较低的 DBP 是 T-FPE 的强烈预测因素。
在接受 EVT 的大梗死核心 AIS 患者中，T-FPE 与 90 天的良好结果相关。
