Document Type
Article
Publication Date
2-18-2020
Abstract
Background and Objective: The first pass effect (FPE; achieving complete recanalization with a single thrombectomy device pass) has been shown to be associated with higher rates of good clinical outcomes in patients with acute ischemic stroke. Here, we investigate clinical and radiographic factors associated with FPE in a large U.S. post-marketing registry (TRACK, Trevo Stent-Retriever Acute Stroke).
Methods: We analyzed the TRACK database (multicenter registry of 634 patients from 23 centers from March 2013 through August 2015), which 609 patients were included in the final analysis. FPE was defined as a single pass/use of device, TICI 2c/3 recanalization, and no use of rescue therapy. Analysis of individual patient data from TRACK were performed to analyze clinical and radiographic characteristics associated with FPE as well-compared clinical outcomes defined as modified Rankin Scale (mRS) score at 30 and 90 days from hospital discharge to the non-FPE group.
Results: The rate of FPE in TRACK was 23% (140/609). There was no association between patient demographics and FPE, including age (p = 0.36), sex (p = 0.50), race (p = 0.50), location of occlusion (p = 0.26), baseline NIHSS (p = 0.62), or past medical history. There was no difference in the use of a balloon-guide catheter or general anesthesia (49 and 57% with FPE vs. 47 and 64%, p = 0.63 and p = 0.14, respectively). Clinical outcomes were significantly associated with FPE; 63 vs. 44% in non-FPE patients achieved mRS 0–2 at 90 days (p = 0.0004).
Conclusion: Our study showed that achieving complete recanalization with a single thrombectomy pass using the Trevo device was highly beneficial. The most common clinical factors that are used to determine eligibility for endovascular therapy, such as NIHSS severity, location of occlusion or patient age were not predictive of the ability to achieve FPE.
Recommended Citation
Mokin, Maxim; Primiani, Christopher T.; Castonguay, Alicia C.; Nogueira, Raul G.; Haussen, Diogo C.; English, Joey D.; Satti, Sudhakar R.; Chen, Jennifer; Farid, Hamed; Borders, Candace; Veznedaroglu, Erol; Binning, Mandy J.; Puri, Ajit; Vora, Nirav A.; Budzik, Ron F.; Dabus, Guilherme; Linfante, Italo; Janardhan, Vallabh; Alshekhlee, Amer; Abraham, Michael G.; Edgell, Randall; Taqi, Muhammad Asif; Khoury, Ramy El; Majjhoo, Anie Q.; Kabbani, Mouhammed R.; Froehler, Michael T.; Finch, Ira; Ansari, Sameer A.; Novakovic, Roberta; Nguyen, Thanh N.; and Zaidat, Osama O., "First Pass Effect in Patients Treated With the Trevo Stent-Retriever: A TRACK Registry Study Analysis." (2020). Department of Radiology Faculty Papers. Paper 80.
https://jdc.jefferson.edu/radiologyfp/80
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
32132966
Language
English
Comments
This article is the author’s final published version in Frontiers in Neurology, Volume 11, February 2020, Article number 83.
The published version is available at https://doi.org/10.3389/fneur.2020.00083. Copyright © Mokin et al.