First pass effect: A new measure for stroke thrombectomy devices

Osama O. Zaidat; Alicia C. Castonguay; Italo Linfante; Rishi Gupta; Coleman O. Martin; William E. Holloway; Nils Mueller-Kronast; Joey D. English; Guilherme Dabus; Tim W. Malisch; Franklin A. Marden; Hormozd Bozorgchami; Andrew Xavier; Ansaar T. Rai; Michael T. Froehler; Aamir Badruddin; Thanh N. Nguyen; M. Asif Taqi; Michael G. Abraham; Albert J. Yoo; Vallabh Janardhan; Hashem Shaltoni; Roberta Novakovic; Alex Abou-Chebl; Peng R. Chen; Gavin W. Britz; Chung Huan J. Sun; Vibhav Bansal; Ritesh Kaushal; Ashish Nanda; Raul G. Nogueira

doi:10.1161/STROKEAHA.117.020315

First pass effect: A new measure for stroke thrombectomy devices

Osama O. Zaidat, Alicia C. Castonguay, Italo Linfante, Rishi Gupta, Coleman O. Martin, William E. Holloway, Nils Mueller-Kronast, Joey D. English, Guilherme Dabus, Tim W. Malisch, Franklin A. Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar T. Rai, Michael T. Froehler, Aamir Badruddin, Thanh N. Nguyen, M. Asif Taqi, Michael G. Abraham, Albert J. YooVallabh Janardhan, Hashem Shaltoni, Roberta Novakovic, Alex Abou-Chebl, Peng R. Chen, Gavin W. Britz, Chung Huan J. Sun, Vibhav Bansal, Ritesh Kaushal, Ashish Nanda, Raul G. Nogueira

Neurology

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

420 Scopus citations

Abstract

Background and Purpose-In acute ischemic stroke, fast and complete recanalization of the occluded vessel is associated with improved outcomes. We describe a novel measure for newer generation devices: The first pass effect (FPE). FPE is defined as achieving a complete recanalization with a single thrombectomy device pass. Methods-The North American Solitaire Acute Stroke Registry database was used to identify a FPE subgroup. Their baseline features and clinical outcomes were compared with non-FPE patients. Clinical outcome measures included 90-days modified Rankin Scale score, National Institutes of Health Stroke Scale score, mortality, and symptomatic intracranial hemorrhage. Multivariate analyses were performed to determine whether FPE independently resulted in improved outcomes and to identify predictors of FPE. Results-A total of 354 acute ischemic stroke patients underwent thrombectomy in the North American Solitaire Acute Stroke registry. FPE was achieved in 89 out of 354 (25.1%). More middle cerebral artery occlusions (64% versus 52.5%) and fewer internal carotid artery occlusions (10.1% versus 27.7%) were present in the FPE group. Balloon guide catheters were used more frequently with FPE (64.0% versus 34.7%). Median time to revascularization was significantly faster in the FPE group (median 34 versus 60 minutes; P=0.0003). FPE was an independent predictor of good clinical outcome (modified Rankin Scale score ≤2 was seen in 61.3% in FPE versus 35.3% in non-FPE cohort; P=0.013; odds ratio, 1.7; 95% confidence interval, 1.1-2.7). The independent predictors of achieving FPE were use of balloon guide catheters and non-internal carotid artery terminus occlusion. Conclusions-The achievement of complete revascularization from a single Solitaire thrombectomy device pass (FPE) is associated with significantly higher rates of good clinical outcome. The FPE is more frequently associated with the use of balloon guide catheters and less likely to be achieved with internal carotid artery terminus occlusion.

Original language	English (US)
Pages (from-to)	660-666
Number of pages	7
Journal	Stroke
Volume	49
Issue number	3
DOIs	https://doi.org/10.1161/STROKEAHA.117.020315
State	Published - 2018

Keywords

First pass
Recanalization
Solitaire
Stent retriever
Stroke
Thrombectomy

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine
Advanced and Specialized Nursing

Access to Document

10.1161/STROKEAHA.117.020315

Cite this

Zaidat, O. O., Castonguay, A. C., Linfante, I., Gupta, R., Martin, C. O., Holloway, W. E., Mueller-Kronast, N., English, J. D., Dabus, G., Malisch, T. W., Marden, F. A., Bozorgchami, H., Xavier, A., Rai, A. T., Froehler, M. T., Badruddin, A., Nguyen, T. N., Asif Taqi, M., Abraham, M. G., ... Nogueira, R. G. (2018). First pass effect: A new measure for stroke thrombectomy devices. Stroke, 49(3), 660-666. https://doi.org/10.1161/STROKEAHA.117.020315

Zaidat, OO, Castonguay, AC, Linfante, I, Gupta, R, Martin, CO, Holloway, WE, Mueller-Kronast, N, English, JD, Dabus, G, Malisch, TW, Marden, FA, Bozorgchami, H, Xavier, A, Rai, AT, Froehler, MT, Badruddin, A, Nguyen, TN, Asif Taqi, M, Abraham, MG, Yoo, AJ, Janardhan, V, Shaltoni, H, Novakovic, R, Abou-Chebl, A, Chen, PR, Britz, GW, Sun, CHJ, Bansal, V, Kaushal, R, Nanda, A & Nogueira, RG 2018, 'First pass effect: A new measure for stroke thrombectomy devices', Stroke, vol. 49, no. 3, pp. 660-666. https://doi.org/10.1161/STROKEAHA.117.020315

@article{e1fed970ce944300a365e6b318844e00,

title = "First pass effect: A new measure for stroke thrombectomy devices",

abstract = "Background and Purpose-In acute ischemic stroke, fast and complete recanalization of the occluded vessel is associated with improved outcomes. We describe a novel measure for newer generation devices: The first pass effect (FPE). FPE is defined as achieving a complete recanalization with a single thrombectomy device pass. Methods-The North American Solitaire Acute Stroke Registry database was used to identify a FPE subgroup. Their baseline features and clinical outcomes were compared with non-FPE patients. Clinical outcome measures included 90-days modified Rankin Scale score, National Institutes of Health Stroke Scale score, mortality, and symptomatic intracranial hemorrhage. Multivariate analyses were performed to determine whether FPE independently resulted in improved outcomes and to identify predictors of FPE. Results-A total of 354 acute ischemic stroke patients underwent thrombectomy in the North American Solitaire Acute Stroke registry. FPE was achieved in 89 out of 354 (25.1%). More middle cerebral artery occlusions (64% versus 52.5%) and fewer internal carotid artery occlusions (10.1% versus 27.7%) were present in the FPE group. Balloon guide catheters were used more frequently with FPE (64.0% versus 34.7%). Median time to revascularization was significantly faster in the FPE group (median 34 versus 60 minutes; P=0.0003). FPE was an independent predictor of good clinical outcome (modified Rankin Scale score ≤2 was seen in 61.3% in FPE versus 35.3% in non-FPE cohort; P=0.013; odds ratio, 1.7; 95% confidence interval, 1.1-2.7). The independent predictors of achieving FPE were use of balloon guide catheters and non-internal carotid artery terminus occlusion. Conclusions-The achievement of complete revascularization from a single Solitaire thrombectomy device pass (FPE) is associated with significantly higher rates of good clinical outcome. The FPE is more frequently associated with the use of balloon guide catheters and less likely to be achieved with internal carotid artery terminus occlusion.",

keywords = "First pass, Recanalization, Solitaire, Stent retriever, Stroke, Thrombectomy",

author = "Zaidat, {Osama O.} and Castonguay, {Alicia C.} and Italo Linfante and Rishi Gupta and Martin, {Coleman O.} and Holloway, {William E.} and Nils Mueller-Kronast and English, {Joey D.} and Guilherme Dabus and Malisch, {Tim W.} and Marden, {Franklin A.} and Hormozd Bozorgchami and Andrew Xavier and Rai, {Ansaar T.} and Froehler, {Michael T.} and Aamir Badruddin and Nguyen, {Thanh N.} and {Asif Taqi}, M. and Abraham, {Michael G.} and Yoo, {Albert J.} and Vallabh Janardhan and Hashem Shaltoni and Roberta Novakovic and Alex Abou-Chebl and Chen, {Peng R.} and Britz, {Gavin W.} and Sun, {Chung Huan J.} and Vibhav Bansal and Ritesh Kaushal and Ashish Nanda and Nogueira, {Raul G.}",

note = "Publisher Copyright: {\textcopyright} 2018 American Heart Association, Inc.",

year = "2018",

doi = "10.1161/STROKEAHA.117.020315",

language = "English (US)",

volume = "49",

pages = "660--666",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

TY - JOUR

T1 - First pass effect

T2 - A new measure for stroke thrombectomy devices

AU - Zaidat, Osama O.

AU - Castonguay, Alicia C.

AU - Linfante, Italo

AU - Gupta, Rishi

AU - Martin, Coleman O.

AU - Holloway, William E.

AU - Mueller-Kronast, Nils

AU - English, Joey D.

AU - Dabus, Guilherme

AU - Malisch, Tim W.

AU - Marden, Franklin A.

AU - Bozorgchami, Hormozd

AU - Xavier, Andrew

AU - Rai, Ansaar T.

AU - Froehler, Michael T.

AU - Badruddin, Aamir

AU - Nguyen, Thanh N.

AU - Asif Taqi, M.

AU - Abraham, Michael G.

AU - Yoo, Albert J.

AU - Janardhan, Vallabh

AU - Shaltoni, Hashem

AU - Novakovic, Roberta

AU - Abou-Chebl, Alex

AU - Chen, Peng R.

AU - Britz, Gavin W.

AU - Sun, Chung Huan J.

AU - Bansal, Vibhav

AU - Kaushal, Ritesh

AU - Nanda, Ashish

AU - Nogueira, Raul G.

PY - 2018

Y1 - 2018

N2 - Background and Purpose-In acute ischemic stroke, fast and complete recanalization of the occluded vessel is associated with improved outcomes. We describe a novel measure for newer generation devices: The first pass effect (FPE). FPE is defined as achieving a complete recanalization with a single thrombectomy device pass. Methods-The North American Solitaire Acute Stroke Registry database was used to identify a FPE subgroup. Their baseline features and clinical outcomes were compared with non-FPE patients. Clinical outcome measures included 90-days modified Rankin Scale score, National Institutes of Health Stroke Scale score, mortality, and symptomatic intracranial hemorrhage. Multivariate analyses were performed to determine whether FPE independently resulted in improved outcomes and to identify predictors of FPE. Results-A total of 354 acute ischemic stroke patients underwent thrombectomy in the North American Solitaire Acute Stroke registry. FPE was achieved in 89 out of 354 (25.1%). More middle cerebral artery occlusions (64% versus 52.5%) and fewer internal carotid artery occlusions (10.1% versus 27.7%) were present in the FPE group. Balloon guide catheters were used more frequently with FPE (64.0% versus 34.7%). Median time to revascularization was significantly faster in the FPE group (median 34 versus 60 minutes; P=0.0003). FPE was an independent predictor of good clinical outcome (modified Rankin Scale score ≤2 was seen in 61.3% in FPE versus 35.3% in non-FPE cohort; P=0.013; odds ratio, 1.7; 95% confidence interval, 1.1-2.7). The independent predictors of achieving FPE were use of balloon guide catheters and non-internal carotid artery terminus occlusion. Conclusions-The achievement of complete revascularization from a single Solitaire thrombectomy device pass (FPE) is associated with significantly higher rates of good clinical outcome. The FPE is more frequently associated with the use of balloon guide catheters and less likely to be achieved with internal carotid artery terminus occlusion.

AB - Background and Purpose-In acute ischemic stroke, fast and complete recanalization of the occluded vessel is associated with improved outcomes. We describe a novel measure for newer generation devices: The first pass effect (FPE). FPE is defined as achieving a complete recanalization with a single thrombectomy device pass. Methods-The North American Solitaire Acute Stroke Registry database was used to identify a FPE subgroup. Their baseline features and clinical outcomes were compared with non-FPE patients. Clinical outcome measures included 90-days modified Rankin Scale score, National Institutes of Health Stroke Scale score, mortality, and symptomatic intracranial hemorrhage. Multivariate analyses were performed to determine whether FPE independently resulted in improved outcomes and to identify predictors of FPE. Results-A total of 354 acute ischemic stroke patients underwent thrombectomy in the North American Solitaire Acute Stroke registry. FPE was achieved in 89 out of 354 (25.1%). More middle cerebral artery occlusions (64% versus 52.5%) and fewer internal carotid artery occlusions (10.1% versus 27.7%) were present in the FPE group. Balloon guide catheters were used more frequently with FPE (64.0% versus 34.7%). Median time to revascularization was significantly faster in the FPE group (median 34 versus 60 minutes; P=0.0003). FPE was an independent predictor of good clinical outcome (modified Rankin Scale score ≤2 was seen in 61.3% in FPE versus 35.3% in non-FPE cohort; P=0.013; odds ratio, 1.7; 95% confidence interval, 1.1-2.7). The independent predictors of achieving FPE were use of balloon guide catheters and non-internal carotid artery terminus occlusion. Conclusions-The achievement of complete revascularization from a single Solitaire thrombectomy device pass (FPE) is associated with significantly higher rates of good clinical outcome. The FPE is more frequently associated with the use of balloon guide catheters and less likely to be achieved with internal carotid artery terminus occlusion.

KW - First pass

KW - Recanalization

KW - Solitaire

KW - Stent retriever

KW - Stroke

KW - Thrombectomy

UR - http://www.scopus.com/inward/record.url?scp=85043727993&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043727993&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.117.020315

DO - 10.1161/STROKEAHA.117.020315

M3 - Article

C2 - 29459390

AN - SCOPUS:85043727993

SN - 0039-2499

VL - 49

SP - 660

EP - 666

JO - Stroke

JF - Stroke

IS - 3

ER -

First pass effect: A new measure for stroke thrombectomy devices

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this