First Pass Effect: A New Measure for Stroke Thrombectomy Devices

Osama O Zaidat; Alicia C Castonguay; Italo Linfante; Rishi Gupta; Coleman O Martin; William E Holloway; Nils Mueller-Kronast; Joey D English; Guilherme Dabus; Tim W Malisch; Franklin A Marden; Hormozd Bozorgchami; Andrew Xavier; Ansaar T Rai; Michael T Froehler; Aamir Badruddin; Thanh N Nguyen; M Asif Taqi; Michael G Abraham; Albert J Yoo; Vallabh Janardhan; Hashem Shaltoni; Roberta Novakovic; Alex Abou-Chebl; Peng R Chen; Gavin W Britz; Chung-Huan J Sun; Vibhav Bansal; Ritesh Kaushal; Ashish Nanda; Raul G Nogueira

doi:10.1161/STROKEAHA.117.020315

First Pass Effect: A New Measure for Stroke Thrombectomy Devices

Stroke. 2018 Mar;49(3):660-666. doi: 10.1161/STROKEAHA.117.020315. Epub 2018 Feb 19.

Authors

Osama O Zaidat¹, Alicia C Castonguay², Italo Linfante², Rishi Gupta², Coleman O Martin², William E Holloway², Nils Mueller-Kronast², Joey D English², Guilherme Dabus², Tim W Malisch², Franklin A Marden², Hormozd Bozorgchami², Andrew Xavier², Ansaar T Rai², Michael T Froehler², Aamir Badruddin², Thanh N Nguyen², M Asif Taqi², Michael G Abraham², Albert J Yoo², Vallabh Janardhan², Hashem Shaltoni², Roberta Novakovic², Alex Abou-Chebl², Peng R Chen², Gavin W Britz², Chung-Huan J Sun², Vibhav Bansal², Ritesh Kaushal², Ashish Nanda², Raul G Nogueira²

Affiliations

¹ From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke's Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J.D.E.); Alexian Brothers Medical Center, Elk Grove Village, IL (T.W.M., F.A.M.); Oregon Health and Science University, Portland (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown (A.T.R.); Departments of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Department of Neurosurgery, Presence Saint Joseph Medical Center, Joliet, IL (A.B.); Department of Neurology (T.N.N.), Department of Neurosurgery (T.N.N.), and Department of Radiology (T.N.N.), Boston Medical Center, MA; Los Robles Medical Center, Thousand Oaks, CA (M.A.T.); University of Kansas Medical Center, Kansas City (M.G.A.); Texas Stroke Institute, Dallas-Forth Worth (A.J.Y, V.J.); Department of Neurology, University of Texas Medical Branch, Galveston (H.S.); Department of Neurology (R.N.), Department of Neurosurgery (R.N.), and Department of Radiology (R.N.), UT Southwestern Medical Center, Dallas, TX; Baptist Health System, Louisville, KY (A.A.-C.); Department of Neurosurgery, University of Texas Medical School, Houston (P.R.C); Department of Neurosurgery, Methodist Neurological Institute, Houston, TX (G.W.B.); Department of Neurology (C.-H.J.S., R.G.N.), Department of Neurosurgery (C.-H.J.S., R.G.N.), and Department of Radiology (C.-H.J.S., R.G.N.), Emory University School of Medicine, Atlanta, GA; and SSM Health, St. Louis, MO (A.N.). oozaidat@mercy.com.
² From the Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Neuroscience Center, Wellstar Health System, Atlanta, GA (R.G.); Neurointerventional and Diagnostic Associates, Saint Luke's Hospital, Kansas City, MO (C.O.M, W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K., R.K.); California Pacific Medical Center, San Francisco (J.D.E.); Alexian Brothers Medical Center, Elk Grove Village, IL (T.W.M., F.A.M.); Oregon Health and Science University, Portland (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown (A.T.R.); Departments of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Department of Neurosurgery, Presence Saint Joseph Medical Center, Joliet, IL (A.B.); Department of Neurology (T.N.N.), Department of Neurosurgery (T.N.N.), and Department of Radiology (T.N.N.), Boston Medical Center, MA; Los Robles Medical Center, Thousand Oaks, CA (M.A.T.); University of Kansas Medical Center, Kansas City (M.G.A.); Texas Stroke Institute, Dallas-Forth Worth (A.J.Y, V.J.); Department of Neurology, University of Texas Medical Branch, Galveston (H.S.); Department of Neurology (R.N.), Department of Neurosurgery (R.N.), and Department of Radiology (R.N.), UT Southwestern Medical Center, Dallas, TX; Baptist Health System, Louisville, KY (A.A.-C.); Department of Neurosurgery, University of Texas Medical School, Houston (P.R.C); Department of Neurosurgery, Methodist Neurological Institute, Houston, TX (G.W.B.); Department of Neurology (C.-H.J.S., R.G.N.), Department of Neurosurgery (C.-H.J.S., R.G.N.), and Department of Radiology (C.-H.J.S., R.G.N.), Emory University School of Medicine, Atlanta, GA; and SSM Health, St. Louis, MO (A.N.).

PMID: 29459390
DOI: 10.1161/STROKEAHA.117.020315

Abstract

Background and purpose: In acute ischemic stroke, fast and complete recanalization of the occluded vessel is associated with improved outcomes. We describe a novel measure for newer generation devices: the first pass effect (FPE). FPE is defined as achieving a complete recanalization with a single thrombectomy device pass.

Methods: The North American Solitaire Acute Stroke Registry database was used to identify a FPE subgroup. Their baseline features and clinical outcomes were compared with non-FPE patients. Clinical outcome measures included 90-days modified Rankin Scale score, National Institutes of Health Stroke Scale score, mortality, and symptomatic intracranial hemorrhage. Multivariate analyses were performed to determine whether FPE independently resulted in improved outcomes and to identify predictors of FPE.

Results: A total of 354 acute ischemic stroke patients underwent thrombectomy in the North American Solitaire Acute Stroke registry. FPE was achieved in 89 out of 354 (25.1%). More middle cerebral artery occlusions (64% versus 52.5%) and fewer internal carotid artery occlusions (10.1% versus 27.7%) were present in the FPE group. Balloon guide catheters were used more frequently with FPE (64.0% versus 34.7%). Median time to revascularization was significantly faster in the FPE group (median 34 versus 60 minutes; P=0.0003). FPE was an independent predictor of good clinical outcome (modified Rankin Scale score ≤2 was seen in 61.3% in FPE versus 35.3% in non-FPE cohort; P=0.013; odds ratio, 1.7; 95% confidence interval, 1.1-2.7). The independent predictors of achieving FPE were use of balloon guide catheters and non-internal carotid artery terminus occlusion.

Conclusions: The achievement of complete revascularization from a single Solitaire thrombectomy device pass (FPE) is associated with significantly higher rates of good clinical outcome. The FPE is more frequently associated with the use of balloon guide catheters and less likely to be achieved with internal carotid artery terminus occlusion.

Keywords: Solitaire; first pass; recanalization; stent retriever; stroke; thrombectomy.

Publication types

Clinical Trial
Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Brain Ischemia* / mortality
Brain Ischemia* / surgery
Female
Humans
Intracranial Hemorrhages* / mortality
Intracranial Hemorrhages* / surgery
Male
Middle Aged
Registries*
Stroke* / mortality
Stroke* / surgery
Thrombectomy* / instrumentation
Thrombectomy* / methods
United States / epidemiology