Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke

Andrew B. Koo; Benjamin C. Reeves; Daniela Renedo; Ilko L. Maier; Sami Al Kasab; Pascal Jabbour; Joon Tae Kim; Stacey Q. Wolfe; Ansaar Rai; Robert M. Starke; Marios Nikos Psychogios; Amir Shaban; Adam Arthur; Shinichi Yoshimura; Hugo Cuellar; Jonathan A. Grossberg; Ali Alawieh; Daniele G. Romano; Omar Tanweer; Justin Mascitelli; Isabel Fragata; Adam Polifka; Joshua Osbun; Roberto Crosa; Min S. Park; Michael R. Levitt; Waleed Brinjikji; Mark Moss; Travis Dumont; Richard Williamson; Pedro Navia; Peter Kan; Alejandro M. Spiotta; Kevin N. Sheth; Adam De Havenon; Charles C. Matouk

doi:10.1227/neu.0000000000002900

Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke

Andrew B. Koo, Benjamin C. Reeves, Daniela Renedo, Ilko L. Maier, Sami Al Kasab, Pascal Jabbour, Joon Tae Kim, Stacey Q. Wolfe, Ansaar Rai, Robert M. Starke, Marios Nikos Psychogios, Amir Shaban, Adam Arthur, Shinichi Yoshimura, Hugo Cuellar, Jonathan A. Grossberg, Ali Alawieh, Daniele G. Romano, Omar Tanweer, Justin MascitelliIsabel Fragata, Adam Polifka, Joshua Osbun, Roberto Crosa, Min S. Park, Michael R. Levitt, Waleed Brinjikji, Mark Moss, Travis Dumont, Richard Williamson, Pedro Navia, Peter Kan, Alejandro M. Spiotta, Kevin N. Sheth, Adam De Havenon, Charles C. Matouk

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

1 Scopus citations

Abstract

BACKGROUND AND OBJECTIVES: First pass effect (FPE) is a metric increasingly used to determine the success of mechanical thrombectomy (MT) procedures. However, few studies have investigated whether the duration of the procedure can modify the clinical benefit of FPE. We sought to determine whether FPE after MT for anterior circulation large vessel occlusion acute ischemic stroke is modified by procedural time (PT). METHODS: A multicenter, international data set was retrospectively analyzed for anterior circulation large vessel occlusion acute ischemic stroke treated by MT who achieved excellent reperfusion (thrombolysis in cerebral infarction 2c/3). The primary outcome was good functional outcome defined by 90-day modified Rankin scale scores of 0-2. The primary study exposure was first pass success (FPS, 1 pass vs ≥2 passes) and the secondary exposure was PT. We fit-adjusted logistic regression models and used marginal effects to assess the interaction between PT (≤30 vs >30 minutes) and FPS, adjusting for potential confounders including time from stroke presentation. RESULTS: A total of 1310 patients had excellent reperfusion. These patients were divided into 2 cohorts based on PT: ≤30 minutes (777 patients, 59.3%) and >30 minutes (533 patients, 40.7%). Good functional outcome was observed in 658 patients (50.2%). The interaction term between FPS and PT was significant (P =.018). Individuals with FPS in ≤30 minutes had 11.5% higher adjusted predicted probability of good outcome compared with those who required ≥2 passes (58.2% vs 46.7%, P =.001). However, there was no significant difference in the adjusted predicted probability of good outcome in individuals with PT >30 minutes. This relationship appeared identical in models with PT treated as a continuous variable. CONCLUSION: FPE is modified by PT, with the added clinical benefit lost in longer procedures greater than 30 minutes. A comprehensive metric for MT procedures, namely, FPE 30, may better represent the ideal of fast, complete reperfusion with a single pass of a thrombectomy device.

Original language	English (US)
Pages (from-to)	128-136
Number of pages	9
Journal	Neurosurgery
Volume	95
Issue number	1
DOIs	https://doi.org/10.1227/neu.0000000000002900
State	Published - Jul 1 2024
Externally published	Yes

Keywords

First pass effect
Mechanical thrombectomy
Stroke

ASJC Scopus subject areas

Surgery
Clinical Neurology

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Koo, A. B., Reeves, B. C., Renedo, D., Maier, I. L., Al Kasab, S., Jabbour, P., Kim, J. T., Wolfe, S. Q., Rai, A., Starke, R. M., Psychogios, M. N., Shaban, A., Arthur, A., Yoshimura, S., Cuellar, H., Grossberg, J. A., Alawieh, A., Romano, D. G., Tanweer, O., ... Matouk, C. C. (2024). Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke. Neurosurgery, 95(1), 128-136. https://doi.org/10.1227/neu.0000000000002900

Koo, AB, Reeves, BC, Renedo, D, Maier, IL, Al Kasab, S, Jabbour, P, Kim, JT, Wolfe, SQ, Rai, A, Starke, RM, Psychogios, MN, Shaban, A, Arthur, A, Yoshimura, S, Cuellar, H, Grossberg, JA, Alawieh, A, Romano, DG, Tanweer, O, Mascitelli, J, Fragata, I, Polifka, A, Osbun, J, Crosa, R, Park, MS, Levitt, MR, Brinjikji, W, Moss, M, Dumont, T, Williamson, R, Navia, P, Kan, P, Spiotta, AM, Sheth, KN, De Havenon, A & Matouk, CC 2024, 'Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke', Neurosurgery, vol. 95, no. 1, pp. 128-136. https://doi.org/10.1227/neu.0000000000002900

@article{511b70417c2342e58ad65c4650d86c4a,

title = "Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke",

abstract = "BACKGROUND AND OBJECTIVES: First pass effect (FPE) is a metric increasingly used to determine the success of mechanical thrombectomy (MT) procedures. However, few studies have investigated whether the duration of the procedure can modify the clinical benefit of FPE. We sought to determine whether FPE after MT for anterior circulation large vessel occlusion acute ischemic stroke is modified by procedural time (PT). METHODS: A multicenter, international data set was retrospectively analyzed for anterior circulation large vessel occlusion acute ischemic stroke treated by MT who achieved excellent reperfusion (thrombolysis in cerebral infarction 2c/3). The primary outcome was good functional outcome defined by 90-day modified Rankin scale scores of 0-2. The primary study exposure was first pass success (FPS, 1 pass vs ≥2 passes) and the secondary exposure was PT. We fit-adjusted logistic regression models and used marginal effects to assess the interaction between PT (≤30 vs >30 minutes) and FPS, adjusting for potential confounders including time from stroke presentation. RESULTS: A total of 1310 patients had excellent reperfusion. These patients were divided into 2 cohorts based on PT: ≤30 minutes (777 patients, 59.3%) and >30 minutes (533 patients, 40.7%). Good functional outcome was observed in 658 patients (50.2%). The interaction term between FPS and PT was significant (P =.018). Individuals with FPS in ≤30 minutes had 11.5% higher adjusted predicted probability of good outcome compared with those who required ≥2 passes (58.2% vs 46.7%, P =.001). However, there was no significant difference in the adjusted predicted probability of good outcome in individuals with PT >30 minutes. This relationship appeared identical in models with PT treated as a continuous variable. CONCLUSION: FPE is modified by PT, with the added clinical benefit lost in longer procedures greater than 30 minutes. A comprehensive metric for MT procedures, namely, FPE 30, may better represent the ideal of fast, complete reperfusion with a single pass of a thrombectomy device.",

keywords = "First pass effect, Mechanical thrombectomy, Stroke",

author = "Koo, {Andrew B.} and Reeves, {Benjamin C.} and Daniela Renedo and Maier, {Ilko L.} and {Al Kasab}, Sami and Pascal Jabbour and Kim, {Joon Tae} and Wolfe, {Stacey Q.} and Ansaar Rai and Starke, {Robert M.} and Psychogios, {Marios Nikos} and Amir Shaban and Adam Arthur and Shinichi Yoshimura and Hugo Cuellar and Grossberg, {Jonathan A.} and Ali Alawieh and Romano, {Daniele G.} and Omar Tanweer and Justin Mascitelli and Isabel Fragata and Adam Polifka and Joshua Osbun and Roberto Crosa and Park, {Min S.} and Levitt, {Michael R.} and Waleed Brinjikji and Mark Moss and Travis Dumont and Richard Williamson and Pedro Navia and Peter Kan and Spiotta, {Alejandro M.} and Sheth, {Kevin N.} and {De Havenon}, Adam and Matouk, {Charles C.}",

year = "2024",

month = jul,

day = "1",

doi = "10.1227/neu.0000000000002900",

language = "English (US)",

volume = "95",

pages = "128--136",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

TY - JOUR

T1 - Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke

AU - Koo, Andrew B.

AU - Reeves, Benjamin C.

AU - Renedo, Daniela

AU - Maier, Ilko L.

AU - Al Kasab, Sami

AU - Jabbour, Pascal

AU - Kim, Joon Tae

AU - Wolfe, Stacey Q.

AU - Rai, Ansaar

AU - Starke, Robert M.

AU - Psychogios, Marios Nikos

AU - Shaban, Amir

AU - Arthur, Adam

AU - Yoshimura, Shinichi

AU - Cuellar, Hugo

AU - Grossberg, Jonathan A.

AU - Alawieh, Ali

AU - Romano, Daniele G.

AU - Tanweer, Omar

AU - Mascitelli, Justin

AU - Fragata, Isabel

AU - Polifka, Adam

AU - Osbun, Joshua

AU - Crosa, Roberto

AU - Park, Min S.

AU - Levitt, Michael R.

AU - Brinjikji, Waleed

AU - Moss, Mark

AU - Dumont, Travis

AU - Williamson, Richard

AU - Navia, Pedro

AU - Kan, Peter

AU - Spiotta, Alejandro M.

AU - Sheth, Kevin N.

AU - De Havenon, Adam

AU - Matouk, Charles C.

PY - 2024/7/1

Y1 - 2024/7/1

N2 - BACKGROUND AND OBJECTIVES: First pass effect (FPE) is a metric increasingly used to determine the success of mechanical thrombectomy (MT) procedures. However, few studies have investigated whether the duration of the procedure can modify the clinical benefit of FPE. We sought to determine whether FPE after MT for anterior circulation large vessel occlusion acute ischemic stroke is modified by procedural time (PT). METHODS: A multicenter, international data set was retrospectively analyzed for anterior circulation large vessel occlusion acute ischemic stroke treated by MT who achieved excellent reperfusion (thrombolysis in cerebral infarction 2c/3). The primary outcome was good functional outcome defined by 90-day modified Rankin scale scores of 0-2. The primary study exposure was first pass success (FPS, 1 pass vs ≥2 passes) and the secondary exposure was PT. We fit-adjusted logistic regression models and used marginal effects to assess the interaction between PT (≤30 vs >30 minutes) and FPS, adjusting for potential confounders including time from stroke presentation. RESULTS: A total of 1310 patients had excellent reperfusion. These patients were divided into 2 cohorts based on PT: ≤30 minutes (777 patients, 59.3%) and >30 minutes (533 patients, 40.7%). Good functional outcome was observed in 658 patients (50.2%). The interaction term between FPS and PT was significant (P =.018). Individuals with FPS in ≤30 minutes had 11.5% higher adjusted predicted probability of good outcome compared with those who required ≥2 passes (58.2% vs 46.7%, P =.001). However, there was no significant difference in the adjusted predicted probability of good outcome in individuals with PT >30 minutes. This relationship appeared identical in models with PT treated as a continuous variable. CONCLUSION: FPE is modified by PT, with the added clinical benefit lost in longer procedures greater than 30 minutes. A comprehensive metric for MT procedures, namely, FPE 30, may better represent the ideal of fast, complete reperfusion with a single pass of a thrombectomy device.

AB - BACKGROUND AND OBJECTIVES: First pass effect (FPE) is a metric increasingly used to determine the success of mechanical thrombectomy (MT) procedures. However, few studies have investigated whether the duration of the procedure can modify the clinical benefit of FPE. We sought to determine whether FPE after MT for anterior circulation large vessel occlusion acute ischemic stroke is modified by procedural time (PT). METHODS: A multicenter, international data set was retrospectively analyzed for anterior circulation large vessel occlusion acute ischemic stroke treated by MT who achieved excellent reperfusion (thrombolysis in cerebral infarction 2c/3). The primary outcome was good functional outcome defined by 90-day modified Rankin scale scores of 0-2. The primary study exposure was first pass success (FPS, 1 pass vs ≥2 passes) and the secondary exposure was PT. We fit-adjusted logistic regression models and used marginal effects to assess the interaction between PT (≤30 vs >30 minutes) and FPS, adjusting for potential confounders including time from stroke presentation. RESULTS: A total of 1310 patients had excellent reperfusion. These patients were divided into 2 cohorts based on PT: ≤30 minutes (777 patients, 59.3%) and >30 minutes (533 patients, 40.7%). Good functional outcome was observed in 658 patients (50.2%). The interaction term between FPS and PT was significant (P =.018). Individuals with FPS in ≤30 minutes had 11.5% higher adjusted predicted probability of good outcome compared with those who required ≥2 passes (58.2% vs 46.7%, P =.001). However, there was no significant difference in the adjusted predicted probability of good outcome in individuals with PT >30 minutes. This relationship appeared identical in models with PT treated as a continuous variable. CONCLUSION: FPE is modified by PT, with the added clinical benefit lost in longer procedures greater than 30 minutes. A comprehensive metric for MT procedures, namely, FPE 30, may better represent the ideal of fast, complete reperfusion with a single pass of a thrombectomy device.

KW - First pass effect

KW - Mechanical thrombectomy

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85199521939&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85199521939&partnerID=8YFLogxK

U2 - 10.1227/neu.0000000000002900

DO - 10.1227/neu.0000000000002900

M3 - Article

C2 - 38483158

AN - SCOPUS:85199521939

SN - 0148-396X

VL - 95

SP - 128

EP - 136

JO - Neurosurgery

JF - Neurosurgery

IS - 1

ER -

Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke

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