[en] [en] BACKGROUND AND PURPOSE: In the settings of thrombectomy, the first-pass effect (FPE), defined by a complete recanalization after one pass with no rescue therapy, has been shown to be associated with an improved outcome. As this phenomenon has been predominantly described in anterior circulation strokes, we aimed to study the prevalence, outcomes, and predictors of FPE in patients with a basilar artery occlusion.
METHODS: From a prospective multicentric registry, we collected the data of all consecutive basilar artery occlusion patients who underwent thrombectomy and compared the outcomes of patients who achieved FPE and those who did not. We also compared FPE patients with those who achieved a complete recanalization with >1 pass. Finally, a multivariate analysis was performed to determine the predictors of FPE.
RESULTS: Data from 280 patients were analyzed in our study, including 84 of 280 patients (30%) with an atheromatous etiology. An FPE was achieved in 93 patients (33.2%), with a significantly higher proportion of good outcomes (modified Rankin Scale score 0-2 at 3 months) and lower mortality than non-FPE patients. An FPE was also associated with improved outcomes compared with patients who went on to have full recanalization with >1 pass. Contact aspiration as first-line strategy was a strong predictor of FPE, whereas baseline antiplatelets and atheromatous etiology were negative predictors.
CONCLUSIONS: In our study, an FPE was achieved in approximately one-third of patients with a basilar artery occlusion and was associated with improved outcomes. More research is needed to improve devices and techniques to increase the incidence of FPE. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03776877.
Disciplines :
Neurology
Author, co-author :
Aubertin, Mathilde; Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F
Weisenburger-Lile, David; Neurovascular Unit, Foch Hospital, Suresnes, France (D.W.-L., B.L
Gory, Benjamin ; Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy (B.G.), Université de Lorraine, France ; Imagerie Adaptative Diagnostique et Interventionnelle, INSERM U1254 (B.G.), Université de Lorraine, France
Richard, Sébastien ; Stroke Unit, Department of Neurology, CHRU-Nancy (S.R.), Université de Lorraine, France ; INSERM U1116, CHRU-Nancy, France (S.R
Blanc, Raphael ; Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F
Ducroux, Célina; Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F
Piotin, Michel ; Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F
Labreuche, Julien ; Université de Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, France (J.L
Lucas, Ludovic; Neurovascular Unit, Centre Hospitalier Universitaire de Bordeaux, France (L.L
Dargazanli, Cyril ; Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France (C. Dargazanli, A.B
Benali, Amel; Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France (C. Dargazanli, A.B
Bourcier, Romain ; Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, Université de Nantes, France (R. Bourcier, L.D
Detraz, Lili; Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, Université de Nantes, France (R. Bourcier, L.D
Vannier, Stéphane ; Department of Neurology, Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (S.V., M.G
Guillen, Maud ; Department of Neurology, Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (S.V., M.G
Eugene, François ; Department of Neuroradiology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France (F.E
Walker, Gregory; Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada (G.W., R.L., R.F ; Department of Medicine, Division of Neurology, Royal Columbian Hospital, New Westminster, University of British Columbia, Canada (G.W
Lun, Ronda ; Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada (G.W., R.L., R.F
Guenego, Adrien ; Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F ; Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G
Consoli, Arturo ; Department of Neuroradiology, Foch Hospital, Suresnes, France (A.C
Marnat, Gaultier ; Department of Neuroradiology, Centre Hospitalier Universitaire de Bordeaux, France (G.M
Maier, Benjamin ; Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F
Lapergue, Bertrand; Neurovascular Unit, Foch Hospital, Suresnes, France (D.W.-L., B.L
Fahed, Robert ; Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France (M.A., R. Blanc, C. Ducroux, M.P., A.G., B.M., R.F ; Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ontario, Canada (G.W., R.L., R.F
J. Labreuche received fees for performing statistical analyses for the present study. Dr Eugene reports personal fees and nonfinancial support from Biomodex outside the submitted work. Dr Lapergue reports grants from Stryker, Penumbra, Microvention, and Balt outside the submitted work. The corresponding author (Dr Fahed) has full access to all the data in the study and has final responsibility for the decision to submit for publication. The other authors report no conflicts.
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