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

Research output: Contribution to journalArticlepeer-review


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 languageEnglish (US)
Pages (from-to)114-123
Number of pages10
JournalEuropean Stroke Journal
Issue number1
StatePublished - Mar 2024
Externally publishedYes


  • MeVO
  • Stroke
  • outcomes research
  • reperfusion
  • thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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