Journal article
Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke
Neurosurgery, Vol.95(1), pp.128-136
07/2024
DOI: 10.1227/neu.0000000000002900
PMID: 38483158
Abstract
First pass effect (FPE) is a metric increasingly used to determine the success of mechanical thrombectomy (MT) procedures. However, few studies have investigated whether the duration of the procedure can modify the clinical benefit of FPE. We sought to determine whether FPE after MT for anterior circulation large vessel occlusion acute ischemic stroke is modified by procedural time (PT).
A multicenter, international data set was retrospectively analyzed for anterior circulation large vessel occlusion acute ischemic stroke treated by MT who achieved excellent reperfusion (thrombolysis in cerebral infarction 2c/3). The primary outcome was good functional outcome defined by 90-day modified Rankin scale scores of 0-2. The primary study exposure was first pass success (FPS, 1 pass vs ≥2 passes) and the secondary exposure was PT. We fit-adjusted logistic regression models and used marginal effects to assess the interaction between PT (≤30 vs >30 minutes) and FPS, adjusting for potential confounders including time from stroke presentation.
A total of 1310 patients had excellent reperfusion. These patients were divided into 2 cohorts based on PT: ≤30 minutes (777 patients, 59.3%) and >30 minutes (533 patients, 40.7%). Good functional outcome was observed in 658 patients (50.2%). The interaction term between FPS and PT was significant ( P = .018). Individuals with FPS in ≤30 minutes had 11.5% higher adjusted predicted probability of good outcome compared with those who required ≥2 passes (58.2% vs 46.7%, P = .001). However, there was no significant difference in the adjusted predicted probability of good outcome in individuals with PT >30 minutes. This relationship appeared identical in models with PT treated as a continuous variable.
FPE is modified by PT, with the added clinical benefit lost in longer procedures greater than 30 minutes. A comprehensive metric for MT procedures, namely, FPE 30 , may better represent the ideal of fast, complete reperfusion with a single pass of a thrombectomy device.
Details
- Title: Subtitle
- Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke
- Creators
- Andrew B Koo - Yale UniversityBenjamin C Reeves - Yale UniversityDaniela Renedo - Yale UniversityIlko L Maier - Universitätsmedizin GöttingenSami Al Kasab - Medical University of South CarolinaPascal Jabbour - Thomas Jefferson UniversityJoon-Tae Kim - Chonnam National University HospitalStacey Q Wolfe - Wake Forest UniversityAnsaar Rai - West Virginia UniversityRobert M Starke - University of Miami Health SystemMarios-Nikos Psychogios - University of BaselAmir Shaban - University of IowaAdam Arthur - University of Tennessee Health Science CenterShinichi Yoshimura - Hyogo Medical UniversityHugo Cuellar - Louisiana State University in ShreveportJonathan A Grossberg - Emory UniversityAli Alawieh - Emory UniversityDaniele G Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaOmar Tanweer - Baylor College of MedicineJustin Mascitelli - The University of Texas Health Science Center at San AntonioIsabel Fragata - Unidade Local de Saúde de São JoséAdam Polifka - University of FloridaJoshua Osbun - Washington University in St. LouisRoberto Crosa - Universidad de MontevideoMin S Park - University of VirginiaMichael R Levitt - University of WashingtonWaleed Brinjikji - Mayo ClinicMark Moss - Washington Regional Medical CenterTravis Dumont - University of ArizonaRichard Williamson Jr - Allegheny General HospitalPedro Navia - Hospital Universitario La PazPeter Kan - The University of Texas Medical Branch at GalvestonAlejandro M Spiotta - Medical University of South CarolinaKevin N Sheth - Yale UniversityAdam de Havenon - Yale UniversityCharles C Matouk - Yale University
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.95(1), pp.128-136
- DOI
- 10.1227/neu.0000000000002900
- PMID
- 38483158
- NLM abbreviation
- Neurosurgery
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Language
- English
- Electronic publication date
- 03/14/2024
- Date published
- 07/2024
- Academic Unit
- Neurology
- Record Identifier
- 9984572379302771
Metrics
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