In patients undergoing neurothrombectomy, absence of internal carotid artery occlusion, the use of a balloon-guided catheter, and better collateral grade are predictors of achieving complete revascularization after a single attempt, according to study results published in the Journal of NeuroInterventional Surgery.

Previous studies have reported better results following complete revascularization after a single attempt with mechanical thrombectomy in acute ischemic stroke secondary to large vessel occlusion. The goal of the current study was to explore predictors of revascularization after a single attempt, or first pass effect (FPE), in patients undergoing thrombectomy.

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The researchers collected complete data for 930 patients undergoing neurothrombectomy with the Solitaire device from the STRATIS registry.

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In total, FPE was achieved in 372 (40%) patients. The researchers found that patients in the FPE group were older compared with the non-FPE group (mean age 69±15 years vs 67±15 years, respectively, P =.02) and they had less occlusion of the internal carotid artery (17% vs 28%, respectively, P =.001).

At 90 days, rates of functional recovery according to modified Rankin scale of 0 to 2, were higher in the FPE group compared with the non-FPE group (66% vs 49%, P ≤.001), and mortality rates were lower (12% vs 19%, respectively, P =.008). However, rates of symptomatic intracranial hemorrhage were comparable (0.6% vs 2.2%, respectively, P =.13).

Absence of internal carotid artery occlusion (P =.01), the use of a balloon-guided catheter (P =.001), and better collateral grade (P ≤.001) were identified as independent predictors of FPE.

This study has identified several possible predictors of FPE, and the researchers note that “further understanding of these factors may influence choice of thrombectomy device and technique.”


Jadhav A, Zaidat O, Desai S, et al. Predictors of the first pass effect with neurothrombectomy for acute ischemic stroke. J Neurointerv Surg. 2019:11:A1.