First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study

Răzvan Alexandru Radu; Vincent Costalat; Robert Fahed; Sherief Ghozy; James E. Siegler; Hamza Shaikh; Jane Khalife; Mohamad Abdalkader; Piers Klein; Thanh N. Nguyen; Jeremy J. Heit; Ahmad Sweid; Kareem El Naamani; Robert W. Regenhardt; Jose Danilo Bengzon Diestro; Nicole M. Cancelliere; Abdelaziz Amllay; Lukas Meyer; Anne Dusart; Flavio Bellante; Géraud Forestier; Aymeric Rouchaud; Suzana Saleme; Charbel Mounayer; Jens Fiehler; Anna Luisa Kühn; Ajit S. Puri; Christian Dyzmann; Peter T. Kan; Marco Colasurdo; Gaultier Marnat; Jérôme Berge; Xavier Barreau; Igor Sibon; Simona Nedelcu; Nils Henninger; Maéva Kyheng; Thomas R. Marotta; Christopher J. Stapleton; James D. Rabinov; Takahiro Ota; Shogo Dofuku; Leonard L.L. Yeo; Benjamin Y.Q. Tan; Juan Carlos Martinez-Gutierrez; Sergio Salazar-Marioni; Sunil Sheth; Leonardo Renieri; Carolina Capirossi; Ashkan Mowla; Stavropoula I. Tjoumakaris; Pascal Jabbour; Priyank Khandelwal; Arundhati Biswas; Frédéric Clarençon; Mahmoud Elhorany; Kevin Premat; Iacopo Valente; Alessandro Pedicelli; João Pedro Filipe; Ricardo Varela; Miguel Quintero-Consuegra; Nestor R. Gonzalez; Markus A. Möhlenbruch; Jessica Jesser; Illario Tancredi; Adrien ter Schiphorst; Vivek Yedavalli; Pablo Harker; Lina M. Chervak; Yasmin Aziz; Benjamin Gory; Christian Paul Stracke; Constantin Hecker; Monika Killer-Oberpfalzer; Christoph J. Griessenauer; Ajith J. Thomas; Cheng Yang Hsieh; David S. Liebeskind; Andrea M. Alexandre; Tobias D. Faizy; Charlotte Weyland; Aman B. Patel; Vitor Mendes Pereira; Boris Lubicz; Adam A. Dmytriw; Adrien Guenego

doi:10.1177/23969873231208276

First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study

Răzvan Alexandru Radu, Vincent Costalat, Robert Fahed, Sherief Ghozy, James E. Siegler, Hamza Shaikh, Jane Khalife, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Jeremy J. Heit, Ahmad Sweid, Kareem El Naamani, Robert W. Regenhardt, Jose Danilo Bengzon Diestro, Nicole M. Cancelliere, Abdelaziz Amllay, Lukas Meyer, Anne Dusart, Flavio BellanteGéraud Forestier, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer, Jens Fiehler, Anna Luisa Kühn, Ajit S. Puri, Christian Dyzmann, Peter T. Kan, Marco Colasurdo, Gaultier Marnat, Jérôme Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Maéva Kyheng, Thomas R. Marotta, Christopher J. Stapleton, James D. Rabinov, Takahiro Ota, Shogo Dofuku, Leonard L.L. Yeo, Benjamin Y.Q. Tan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sunil Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Stavropoula I. Tjoumakaris, Pascal Jabbour, Priyank Khandelwal, Arundhati Biswas, Frédéric Clarençon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, João Pedro Filipe, Ricardo Varela, Miguel Quintero-Consuegra, Nestor R. Gonzalez, Markus A. Möhlenbruch, Jessica Jesser, Illario Tancredi, Adrien ter Schiphorst, Vivek Yedavalli, Pablo Harker, Lina M. Chervak, Yasmin Aziz, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Monika Killer-Oberpfalzer, Christoph J. Griessenauer, Ajith J. Thomas, Cheng Yang Hsieh, David S. Liebeskind, Andrea M. Alexandre, Tobias D. Faizy, Charlotte Weyland, Aman B. Patel, Vitor Mendes Pereira, Boris Lubicz, Adam A. Dmytriw, Adrien Guenego

Neurosurgery

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. Patients and Methods: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0–2 at 3 months. Results: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10–2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93–0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59–3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25–0.72) and 0.55 (95% CI, 0.39–0.77), respectively. Conclusion: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.

Original language	English (US)
Pages (from-to)	114-123
Number of pages	10
Journal	European Stroke Journal
Volume	9
Issue number	1
DOIs	https://doi.org/10.1177/23969873231208276
State	Published - Mar 2024

Keywords

MeVO
Stroke
outcomes research
reperfusion
thrombectomy

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine

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10.1177/23969873231208276

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Radu, R. A., Costalat, V., Fahed, R., Ghozy, S., Siegler, J. E., Shaikh, H., Khalife, J., Abdalkader, M., Klein, P., Nguyen, T. N., Heit, J. J., Sweid, A., El Naamani, K., Regenhardt, R. W., Diestro, J. D. B., Cancelliere, N. M., Amllay, A., Meyer, L., Dusart, A., ... Guenego, A. (2024). First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study. European Stroke Journal, 9(1), 114-123. https://doi.org/10.1177/23969873231208276

Radu, RA, Costalat, V, Fahed, R, Ghozy, S, Siegler, JE, Shaikh, H, Khalife, J, Abdalkader, M, Klein, P, Nguyen, TN, Heit, JJ, Sweid, A, El Naamani, K, Regenhardt, RW, Diestro, JDB, Cancelliere, NM, Amllay, A, Meyer, L, Dusart, A, Bellante, F, Forestier, G, Rouchaud, A, Saleme, S, Mounayer, C, Fiehler, J, Kühn, AL, Puri, AS, Dyzmann, C, Kan, PT, Colasurdo, M, Marnat, G, Berge, J, Barreau, X, Sibon, I, Nedelcu, S, Henninger, N, Kyheng, M, Marotta, TR, Stapleton, CJ, Rabinov, JD, Ota, T, Dofuku, S, Yeo, LLL, Tan, BYQ, Martinez-Gutierrez, JC, Salazar-Marioni, S, Sheth, S, Renieri, L, Capirossi, C, Mowla, A, Tjoumakaris, SI, Jabbour, P, Khandelwal, P, Biswas, A, Clarençon, F, Elhorany, M, Premat, K, Valente, I, Pedicelli, A, Pedro Filipe, J, Varela, R, Quintero-Consuegra, M, Gonzalez, NR, Möhlenbruch, MA, Jesser, J, Tancredi, I, ter Schiphorst, A, Yedavalli, V, Harker, P, Chervak, LM, Aziz, Y, Gory, B, Paul Stracke, C, Hecker, C, Killer-Oberpfalzer, M, Griessenauer, CJ, Thomas, AJ, Hsieh, CY, Liebeskind, DS, Alexandre, AM, Faizy, TD, Weyland, C, Patel, AB, Pereira, VM, Lubicz, B, Dmytriw, AA & Guenego, A 2024, 'First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study', European Stroke Journal, vol. 9, no. 1, pp. 114-123. https://doi.org/10.1177/23969873231208276

@article{31bf4d4910ac42d6a2ec02441af01072,

title = "First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study",

abstract = "Introduction: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. Patients and Methods: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0–2 at 3 months. Results: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10–2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93–0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59–3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25–0.72) and 0.55 (95% CI, 0.39–0.77), respectively. Conclusion: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.",

keywords = "MeVO, Stroke, outcomes research, reperfusion, thrombectomy",

author = "Radu, {R{\u a}zvan Alexandru} and Vincent Costalat and Robert Fahed and Sherief Ghozy and Siegler, {James E.} and Hamza Shaikh and Jane Khalife and Mohamad Abdalkader and Piers Klein and Nguyen, {Thanh N.} and Heit, {Jeremy J.} and Ahmad Sweid and {El Naamani}, Kareem and Regenhardt, {Robert W.} and Diestro, {Jose Danilo Bengzon} and Cancelliere, {Nicole M.} and Abdelaziz Amllay and Lukas Meyer and Anne Dusart and Flavio Bellante and G{\'e}raud Forestier and Aymeric Rouchaud and Suzana Saleme and Charbel Mounayer and Jens Fiehler and K{\"u}hn, {Anna Luisa} and Puri, {Ajit S.} and Christian Dyzmann and Kan, {Peter T.} and Marco Colasurdo and Gaultier Marnat and J{\'e}r{\^o}me Berge and Xavier Barreau and Igor Sibon and Simona Nedelcu and Nils Henninger and Ma{\'e}va Kyheng and Marotta, {Thomas R.} and Stapleton, {Christopher J.} and Rabinov, {James D.} and Takahiro Ota and Shogo Dofuku and Yeo, {Leonard L.L.} and Tan, {Benjamin Y.Q.} and Martinez-Gutierrez, {Juan Carlos} and Sergio Salazar-Marioni and Sunil Sheth and Leonardo Renieri and Carolina Capirossi and Ashkan Mowla and Tjoumakaris, {Stavropoula I.} and Pascal Jabbour and Priyank Khandelwal and Arundhati Biswas and Fr{\'e}d{\'e}ric Claren{\c c}on and Mahmoud Elhorany and Kevin Premat and Iacopo Valente and Alessandro Pedicelli and {Pedro Filipe}, Jo{\~a}o and Ricardo Varela and Miguel Quintero-Consuegra and Gonzalez, {Nestor R.} and M{\"o}hlenbruch, {Markus A.} and Jessica Jesser and Illario Tancredi and {ter Schiphorst}, Adrien and Vivek Yedavalli and Pablo Harker and Chervak, {Lina M.} and Yasmin Aziz and Benjamin Gory and {Paul Stracke}, Christian and Constantin Hecker and Monika Killer-Oberpfalzer and Griessenauer, {Christoph J.} and Thomas, {Ajith J.} and Hsieh, {Cheng Yang} and Liebeskind, {David S.} and Alexandre, {Andrea M.} and Faizy, {Tobias D.} and Charlotte Weyland and Patel, {Aman B.} and Pereira, {Vitor Mendes} and Boris Lubicz and Dmytriw, {Adam A.} and Adrien Guenego",

note = "Publisher Copyright: {\textcopyright} European Stroke Organisation 2023.",

year = "2024",

month = mar,

doi = "10.1177/23969873231208276",

language = "English (US)",

volume = "9",

pages = "114--123",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "Sage Publications",

number = "1",

}

TY - JOUR

T1 - First pass effect as an independent predictor of functional outcomes in medium vessel occlusions

T2 - An analysis of an international multicenter study

AU - Radu, Răzvan Alexandru

AU - Costalat, Vincent

AU - Fahed, Robert

AU - Ghozy, Sherief

AU - Siegler, James E.

AU - Shaikh, Hamza

AU - Khalife, Jane

AU - Abdalkader, Mohamad

AU - Klein, Piers

AU - Nguyen, Thanh N.

AU - Heit, Jeremy J.

AU - Sweid, Ahmad

AU - El Naamani, Kareem

AU - Regenhardt, Robert W.

AU - Diestro, Jose Danilo Bengzon

AU - Cancelliere, Nicole M.

AU - Amllay, Abdelaziz

AU - Meyer, Lukas

AU - Dusart, Anne

AU - Bellante, Flavio

AU - Forestier, Géraud

AU - Rouchaud, Aymeric

AU - Saleme, Suzana

AU - Mounayer, Charbel

AU - Fiehler, Jens

AU - Kühn, Anna Luisa

AU - Puri, Ajit S.

AU - Dyzmann, Christian

AU - Kan, Peter T.

AU - Colasurdo, Marco

AU - Marnat, Gaultier

AU - Berge, Jérôme

AU - Barreau, Xavier

AU - Sibon, Igor

AU - Nedelcu, Simona

AU - Henninger, Nils

AU - Kyheng, Maéva

AU - Marotta, Thomas R.

AU - Stapleton, Christopher J.

AU - Rabinov, James D.

AU - Ota, Takahiro

AU - Dofuku, Shogo

AU - Yeo, Leonard L.L.

AU - Tan, Benjamin Y.Q.

AU - Martinez-Gutierrez, Juan Carlos

AU - Salazar-Marioni, Sergio

AU - Sheth, Sunil

AU - Renieri, Leonardo

AU - Capirossi, Carolina

AU - Mowla, Ashkan

AU - Tjoumakaris, Stavropoula I.

AU - Jabbour, Pascal

AU - Khandelwal, Priyank

AU - Biswas, Arundhati

AU - Clarençon, Frédéric

AU - Elhorany, Mahmoud

AU - Premat, Kevin

AU - Valente, Iacopo

AU - Pedicelli, Alessandro

AU - Pedro Filipe, João

AU - Varela, Ricardo

AU - Quintero-Consuegra, Miguel

AU - Gonzalez, Nestor R.

AU - Möhlenbruch, Markus A.

AU - Jesser, Jessica

AU - Tancredi, Illario

AU - ter Schiphorst, Adrien

AU - Yedavalli, Vivek

AU - Harker, Pablo

AU - Chervak, Lina M.

AU - Aziz, Yasmin

AU - Gory, Benjamin

AU - Paul Stracke, Christian

AU - Hecker, Constantin

AU - Killer-Oberpfalzer, Monika

AU - Griessenauer, Christoph J.

AU - Thomas, Ajith J.

AU - Hsieh, Cheng Yang

AU - Liebeskind, David S.

AU - Alexandre, Andrea M.

AU - Faizy, Tobias D.

AU - Weyland, Charlotte

AU - Patel, Aman B.

AU - Pereira, Vitor Mendes

AU - Lubicz, Boris

AU - Dmytriw, Adam A.

AU - Guenego, Adrien

PY - 2024/3

Y1 - 2024/3

N2 - Introduction: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. Patients and Methods: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0–2 at 3 months. Results: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10–2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93–0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59–3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25–0.72) and 0.55 (95% CI, 0.39–0.77), respectively. Conclusion: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.

AB - Introduction: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. Patients and Methods: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0–2 at 3 months. Results: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10–2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93–0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59–3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25–0.72) and 0.55 (95% CI, 0.39–0.77), respectively. Conclusion: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.

KW - MeVO

KW - Stroke

KW - outcomes research

KW - reperfusion

KW - thrombectomy

UR - http://www.scopus.com/inward/record.url?scp=85175348259&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85175348259&partnerID=8YFLogxK

U2 - 10.1177/23969873231208276

DO - 10.1177/23969873231208276

M3 - Article

C2 - 37885243

AN - SCOPUS:85175348259

SN - 2396-9873

VL - 9

SP - 114

EP - 123

JO - European Stroke Journal

JF - European Stroke Journal

IS - 1

ER -

First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study

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