Heitkamp Alexander, Hierholzer Sophie-Maria, Heitkamp Christian, Winkelmeier Laurens, Meyer Lukas, Bechstein Matthias, Geest Vincent, Broocks Gabriel, Brekenfeld Caspar, Flottmann Fabian, Schell Maximilian, Thomalla Götz, Faizy Tobias, Fiehler Jens, Kniep Helge C, Gellißen Susanne
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Department of Neuroradiology, HELIOS Medical Center, Campus of MSH Medical School Hamburg, Schwerin, Germany.
J Neurol. 2025 Jul 11;272(8):504. doi: 10.1007/s00415-025-13235-5.
First pass (FP) recanalization, defined as achieving mTICI 2b or higher in a single thrombectomy attempt, has been linked to better functional recovery in acute ischemic stroke patients. This study aimed to investigate whether the benefits of FP are primarily driven by higher rates of complete reperfusion (mTICI 3) or by faster procedure times.
Data from 3707 patients with middle cerebral artery occlusion and successful recanalization (mTICI 2b or higher) were extracted from the prospectively designed German Stroke Registry (2015-2021). Good functional outcomes were defined as a modified Rankin Scale (mRS) score of ≤ 2 at 90 days. Mediation analysis was used to evaluate the extent to which complete reperfusion (mTICI 3) and shorter groin puncture to recanalization time contributed to improved outcomes.
FP recanalization was associated with significantly better functional outcomes: 46.9% of FP patients achieved an mRS ≤ 2 compared to 37.2% in the multi-pass group. Mediation analysis showed that only 14% of the improved outcomes with FP were explained by higher mTICI 3 rates, while 37% were attributed to faster recanalization times.
The improved outcomes associated with FP recanalization are primarily driven by the speed of reperfusion rather than the degree of complete recanalization. This highlights the importance of minimizing procedure times and the number of thrombectomy attempts. Strategies aimed at optimizing treatment workflows and improving device design to prioritize early and efficient reperfusion after the FP are critical to improving patient outcomes (ClinicalTrials.gov identifier: NCT03356392).
首次通过（FP）再通定义为在单次血栓切除术尝试中达到改良脑梗死溶栓分级（mTICI）2b或更高水平，其与急性缺血性卒中患者更好的功能恢复相关。本研究旨在调查FP的益处主要是由更高的完全再灌注率（mTICI 3）还是更快的手术时间所驱动。
从前瞻性设计的德国卒中登记处（2015 - 2021年）提取3707例大脑中动脉闭塞且成功再通（mTICI 2b或更高）患者的数据。良好的功能结局定义为90天时改良Rankin量表（mRS）评分≤2分。采用中介分析评估完全再灌注（mTICI 3）和从腹股沟穿刺到再通的较短时间对改善结局的贡献程度。
FP再通与显著更好的功能结局相关：46.9%的FP患者mRS≤2分，而多次通过组为37.2%。中介分析表明，FP改善结局中只有14%是由更高的mTICI 3率所解释，而37%归因于更快的再通时间。
与FP再通相关的改善结局主要由再灌注速度而非完全再通程度所驱动。这凸显了尽量减少手术时间和血栓切除术尝试次数的重要性。旨在优化治疗流程和改进设备设计以优先实现FP后早期和高效再灌注的策略对于改善患者结局至关重要（ClinicalTrials.gov标识符：NCT03356392）。
