Han Ning, Jia Yangjuan, Xu Guodong, Zhao Yan, Wang Hebo
Department of Graduate School, Hebei Medical University, Shijiazhuang, 050011, Hebei, China.
Department of Neurointervention, Hebei General Hospital, Shijiazhuang, 050051, China.
Eur J Med Res. 2025 Aug 11;30(1):729. doi: 10.1186/s40001-025-03022-3.
This study aimed to elucidate the impact of the first-pass effect (PFE) on patients with acute terminal internal carotid artery occlusion.
We conducted a retrospective analysis of patients with acute terminal internal carotid artery occlusion who underwent endovascular treatment. PFE was defined as achieving complete revascularization with a single use of the thrombectomy device, without the requirement for salvage therapy during the procedure. The primary functional outcome was measured using the 90-day modified Rankin Scale (mRS). mRS score of 0-3 was defined as a favorable outcome. A comprehensive assessment was performed on baseline patient characteristics, procedural parameters, and clinical outcomes. Multivariate analysis was employed to determine the association between PFE and 90-day functional outcomes.
A total of 150 patients were included, of which 36 (24%) achieved PFE. Compared to the non-PFE group, the PFE group exhibited lower rates of general anesthesia, higher rates of intravenous thrombolysis and aspiration thrombectomy, and a shorter puncture-to-recanalization time. When contrasted with the unfavorable outcome group, the favorable outcome group presented with lower NIHSS scores, shorter puncture-to-recanalization durations, a reduced prevalence of atrial fibrillation, and a higher proportion of PFE. Multivariate analysis revealed that PFE was significantly associated with favorable functional outcomes (mRS 0-3, 49.12% vs. 72.22%; adjusted odds ratio [aOR], 3.78; 95% confidence interval [CI], 1.21-11.81; P = 0.022), yet showed no significant association with secondary or safety outcomes.
This study demonstrates that among patients with acute terminal internal carotid artery occlusion who underwent endovascular treatment, 24% achieved FPE, which was associated with improved 90-days functional outcome.
本研究旨在阐明首过效应（PFE）对急性颈内动脉末端闭塞患者的影响。
我们对接受血管内治疗的急性颈内动脉末端闭塞患者进行了回顾性分析。PFE定义为单次使用取栓装置实现完全再血管化，术中无需补救治疗。主要功能结局采用90天改良Rankin量表（mRS）进行测量。mRS评分为0 - 3定义为良好结局。对患者基线特征、手术参数和临床结局进行了综合评估。采用多变量分析确定PFE与90天功能结局之间的关联。
共纳入150例患者，其中36例（24%）实现了PFE。与非PFE组相比，PFE组全身麻醉率较低，静脉溶栓和抽吸血栓切除术率较高，穿刺至再通时间较短。与不良结局组相比，良好结局组NIHSS评分较低，穿刺至再通持续时间较短，房颤患病率较低，PFE比例较高。多变量分析显示，PFE与良好功能结局显著相关（mRS 0 - 3，49.12% vs. 72.22%；调整优势比[aOR]，3.78；95%置信区间[CI]，1.21 - 11.81；P = 0.022），但与次要或安全性结局无显著关联。
本研究表明，在接受血管内治疗的急性颈内动脉末端闭塞患者中，24%实现了FPE，这与90天功能结局改善相关。
