Department of Radiology
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Health Services Administration | Nervous System Diseases | Neurology | Radiology
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.
Ischemia-reperfusion, brain, endovascualar treatment, stroke, thrombectomy
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Copyright © 2020 Mokin, Primiani, Castonguay, Nogueira, Haussen, English, Satti, Chen, Farid, Borders, Veznedaroglu, Binning, Puri, Vora, Budzik, Dabus, Linfante, Janardhan, Alshekhlee, Abraham, Edgell, Taqi, Khoury, Majjhoo, Kabbani, Froehler, Finch, Ansari, Novakovic, Nguyen and Zaidat. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
DOI of Published Version
Mokin M, Primiani CT, Castonguay AC, Nogueira RG, Haussen DC, English JD, Satti SR, Chen J, Farid H, Borders C, Veznedaroglu E, Binning MJ, Puri A, Vora NA, Budzik RF, Dabus G, Linfante I, Janardhan V, Alshekhlee A, Abraham MG, Edgell R, Taqi MA, Khoury RE, Majjhoo AQ, Kabbani MR, Froehler MT, Finch I, Ansari SA, Novakovic R, Nguyen TN, Zaidat OO. First Pass Effect in Patients Treated With the Trevo Stent-Retriever: A TRACK Registry Study Analysis. Front Neurol. 2020 Feb 18;11:83. doi: 10.3389/fneur.2020.00083. PMID: 32132966; PMCID: PMC7040359. Link to article on publisher's site
Frontiers in neurology
Mokin M, Puri AS. (2020). First Pass Effect in Patients Treated With the Trevo Stent-Retriever: A TRACK Registry Study Analysis. Open Access Articles. https://doi.org/10.3389/fneur.2020.00083. Retrieved from https://escholarship.umassmed.edu/oapubs/4156
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