Journal Article

E-227 Impact of occlusion location and procedural factors on the first-pass effect rate in stroke thrombectomies

Rowley, P, Amans, M, Narsinh, K, A So, Winkler, E, Savastano, L, Hetts, S, Cooke, D, Raper, D

2025

Overview

PurposeRapid revascularization in stroke thrombectomy is associated with improved outcomes in patients with acute ischemic stroke due to intracranial large vessel occlusion (LVO). Higher first-pass effect rate (FPE)— removal of all intracranial thrombus on the first attempt—may translate into a lower risk of morbidity and mortality. We examined the FPE rate retrospectively in stroke thrombectomies performed at UCSF, and we examined possible predictors of FPE.MethodsClinical history and laboratory data were collected from 221 stroke thrombectomy patients at UCSF. Information on the use of BGC, aspiration catheters, and stentrievers was recorded. Endovascular success was evaluated using metrics such as first-pass recanalization, eventual recanalization, the number of device passes, procedure times, and immediate complications like vascular dissection or perforation. Success rates were defined as achieving modified-FPE (mTICI 2b-3) after a single-pass approach, as well as final successful (mTICI 2b-3) and complete (mTICI 2c-3) reperfusion rates. Times from groin puncture to first angiogram and final revascularization were recorded. Data was analyzed using R software, with univariate tests (Chi-square, student’s t-test) performed on potential FPE predictors.ResultsThe FPE rate, defined by complete reperfusion (mTICI 2c-3), was 51.58% (114/221). The overall successful reperfusion rate, defined as mTICI 2b-3, was 61.08% (135/221). Univariate analyses were conducted to assess the impact of potential factors on the FPE. Chi-square analysis on the location of occlusion showed a statistically significant relationship (p<0.01) between occlusion site and FPE success in thrombectomies, with certain locations, such as M1, demonstrating higher FPE success rates than others. Other factors showed no significant differences between the FPE group and the non-FPE group.ConclusionsThe results suggest that the FPE and modified FPE rate in stroke thrombectomies performed at UCSF, is higher than rates reported in other studies. Achieving FPE is important in endovascular stroke therapy, as it has been associated with better clinical outcomes, including reduced mortality in patients with acute ischemic stroke due to intracranial LVO.There is a statistically significant relationship (p<0.01) between occlusion site and FPE success in thrombectomies; patients with more proximal occlusions were more likely to have successful thrombectomy. Other univariate analyses did not identify any significant predictors of FPE among the variables assessed, including patient sex, age, type of stentriever, use of contact aspiration, use of balloon, and administration of TNK or tPA.Abstract E-227 Table 1Procedural factors between FPE vs. non-FPE with p-valuesAbstract E-227 Figure 1Forest plot of odds ratios for occlusion site, stentriever, IV lytics[Figure omitted. See PDF]DisclosuresA. So: None. P. Rowley: None. D. Cooke: None. M. Amans: None. L. Savastano: None. K. Narsinh: None. E. Winkler: None. D. Raper: None. S. Hetts: None.

• Publisher: BMJ Publishing Group LTD
• Subject: Ischemia / Mortality / Stroke / Success