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

Research output: Contribution to journalArticle

51 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)660-666
Number of pages7
JournalStroke
Volume49
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Thrombectomy
Stroke
Equipment and Supplies
Catheters
Internal Carotid Artery
Registries
Cohort Effect
Intracranial Hemorrhages
Middle Cerebral Artery Infarction
National Institutes of Health (U.S.)
Carotid Arteries
Multivariate Analysis
Odds Ratio
Outcome Assessment (Health Care)
Databases
Confidence Intervals
Mortality

Keywords

  • first pass
  • recanalization
  • Solitaire
  • stent retriever
  • stroke
  • thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Zaidat, O. O., Castonguay, A. C., Linfante, I., Gupta, R., Martin, C. O., Holloway, W. E., ... 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

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

In: Stroke, Vol. 49, No. 3, 01.03.2018, p. 660-666.

Research output: Contribution to journalArticle

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, Taqi, MA, 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
Zaidat OO, Castonguay AC, Linfante I, Gupta R, Martin CO, Holloway WE et al. First Pass Effect: A New Measure for Stroke Thrombectomy Devices. Stroke. 2018 Mar 1;49(3):660-666. https://doi.org/10.1161/STROKEAHA.117.020315
Zaidat, Osama O. ; Castonguay, Alicia C. ; Linfante, Italo ; Gupta, Rishi ; Martin, Coleman O. ; Holloway, William E. ; Mueller-Kronast, Nils ; English, Joey D. ; Dabus, Guilherme ; Malisch, Tim W. ; Marden, Franklin A. ; Bozorgchami, Hormozd ; Xavier, Andrew ; Rai, Ansaar T. ; Froehler, Michael T. ; Badruddin, Aamir ; Nguyen, Thanh N. ; Taqi, M. Asif ; Abraham, Michael G. ; Yoo, Albert J. ; Janardhan, Vallabh ; Shaltoni, Hashem ; Novakovic, Roberta ; Abou-Chebl, Alex ; Chen, Peng R. ; Britz, Gavin W. ; Sun, Chung Huan J. ; Bansal, Vibhav ; Kaushal, Ritesh ; Nanda, Ashish ; Nogueira, Raul G. / First Pass Effect : A New Measure for Stroke Thrombectomy Devices. In: Stroke. 2018 ; Vol. 49, No. 3. pp. 660-666.
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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.",
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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 - Taqi, M. Asif

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 - 2018/3/1

Y1 - 2018/3/1

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

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