Agrawal Arjun, Agrawal Akash S, Howell Jase L, Barringer-Hoonhout Sevin B, Fleck James D, Mackey Jason S, DeNardo Andrew J, Gibson Daniel P, Amuluru Krishna, Saleem Yasir, Kulwin Charles G, Payner Troy D, Shah Kushal J, Mocco J, Sahlein Daniel H
Department of Interventional Neuroradiology, Goodman Campbell Brain and Spine, Ascension St Vincent Hospital, Indianapolis, IN, USA.
Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
Interv Neuroradiol. 2025 Jun 27:15910199251351167. doi: 10.1177/15910199251351167.
BackgroundGood clinical outcomes following stroke thrombectomy have been associated with successful reperfusion following a single pass, often referred to as the first pass effect (FPE). Inherent in FPE is a potential association with rapid recanalization. It remains unclear if the benefit associated with FPE is an epiphenomenon rather than a meaningful metric to evaluate thrombectomy. We retrospectively analyzed a high-volume single-practice database to evaluate the association of FPE with good clinical outcome.MethodsA database of 1047 consecutive thrombectomies from 2011 to 2020 was retrospectively queried. Demographics and presentation/procedural metrics were correlated with clinical outcome (3-month modified Rankin Scale (mRS)); patients aged 18 years and older with 3-month clinical follow-ups were included. Univariate analysis was performed to evaluate for an association with good clinical outcome (mRS 0-2) at 90 days. Variables meeting a univariate analysis -value of 0.05 were included in multivariate analyses. Variables included time of onset to recanalization (OTR), onset to puncture (OTP), and puncture to recanalization (PTR), as well as the number of passes.ResultsA total of 685 patients met the criteria for inclusion. Univariate analysis identified nine variables associated with good clinical outcome at 90 days. Multivariate analysis found OTP, patient age, and successful reperfusion (mTICI ≥ 2B) were associated with good clinical outcome. We built a multivariate model across a range of ratios of PTR to OTR. PTR became significantly associated with good clinical outcome ( = 0.044) when PTR/OTR ≥ 3%. Further subset analyses were performed using a conventional definition of FPE. All multivariate analyses revealed time metrics were significantly associated with good clinical outcome while one versus multiple passes was not.ConclusionsThis study demonstrates that time, age, and degree of recanalization are highly associated with good clinical outcome following thrombectomy, whereas the number of passes is not.
背景
卒中血栓切除术良好的临床预后与单次通过后的成功再灌注相关，这通常被称为首次通过效应（FPE）。FPE的内在因素是与快速再通存在潜在关联。目前尚不清楚与FPE相关的益处是一种附带现象，还是评估血栓切除术的一个有意义的指标。我们回顾性分析了一个大容量的单中心数据库，以评估FPE与良好临床预后之间的关联。
方法
回顾性查询了2011年至2020年连续1047例血栓切除术的数据库。人口统计学和临床表现/手术指标与临床预后（3个月改良Rankin量表（mRS））相关；纳入年龄≥18岁且有3个月临床随访的患者。进行单因素分析以评估90天时与良好临床预后（mRS 0 - 2）的相关性。单因素分析P值<0.05的变量纳入多因素分析。变量包括再通时间（OTR）、发病至穿刺时间（OTP）、穿刺至再通时间（PTR）以及通过次数。
结果
共有685例患者符合纳入标准。单因素分析确定了9个与90天时良好临床预后相关的变量。多因素分析发现OTP、患者年龄和成功再灌注（mTICI≥2B）与良好临床预后相关。我们构建了一个跨越一系列PTR与OTR比值的多因素模型。当PTR/OTR≥3%时，PTR与良好临床预后显著相关（P = 0.044）。使用FPE的传统定义进行了进一步的亚组分析。所有多因素分析均显示时间指标与良好临床预后显著相关，而单次通过与多次通过则不然。
结论
本研究表明，时间、年龄和再通程度与血栓切除术后的良好临床预后高度相关，而通过次数则不然。
