NYMC Faculty Publications

First Pass Effect as an Independent Predictor of Functional Outcomes in Medium Vessel Occlusions: An Analysis of an International Multicenter Study

Răzvan Alexandru Radu, Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
Vincent Costalat, Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
Robert Fahed, Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada.
Sherief Ghozy, Department of Radiology, Mayo Clinic, Rochester, MN, USA.
James E. Siegler, Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA.
Hamza Shaikh, Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA.
Jane Khalife, Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA.
Mohamad Abdalkader, Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
Piers Klein, Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
Thanh N. Nguyen, Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
Jeremy J. Heit, Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
Ahmad Sweid, Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Kareem El Naamani, Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
Robert W. Regenhardt, Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Jose Danilo Diestro, Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
Nicole M. Cancelliere, Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
Abdelaziz Amllay, Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
Lukas Meyer, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Anne Dusart, Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
Flavio Bellante, Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
Géraud Forestier, University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
Aymeric Rouchaud, University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
Suzana Saleme, University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
Charbel Mounayer, University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
Jens Fiehler, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Anna Luisa Kühn, Department of Radiology, University of Massachusetts Memorial Hospital, Worcester, MA, USA.
Ajit S. Puri, Department of Radiology, University of Massachusetts Memorial Hospital, Worcester, MA, USA.
Christian Dyzmann, Department of Diagnostic and Interventional Radiology and Neuroradiology, Sana Klinik Lübeck, Lübeck, Germany.
Peter T. Kan, Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA.
Marco Colasurdo, Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA.
Gaultier Marnat, Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
Jérôme Berge, Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.

Author Type(s)

Faculty

Journal Title

European Stroke Journal

First Page

114

Last Page

123

Document Type

Article

Publication Date

3-1-2024

Department

Neurosurgery

Abstract

INTRODUCTION: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. PATIENTS AND METHODS: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0-2 at 3 months. RESULTS: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10-2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93-0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59-3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25-0.72) and 0.55 (95% CI, 0.39-0.77), respectively. CONCLUSION: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.

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