First-Pass Effect in Basilar Artery Occlusions: Insights From the Endovascular Treatment of Ischemic Stroke Registry
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 t...
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Veröffentlicht in: | Stroke 2021-12, Vol.52 (12), p.3777-3785 |
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creator | Aubertin, Mathilde Weisenburger-Lile, David Gory, Benjamin Richard, Sébastien Blanc, Raphael Ducroux, Célina Piotin, Michel Labreuche, Julien Lucas, Ludovic Dargazanli, Cyril Benali, Amel Bourcier, Romain Detraz, Lili Vannier, Stéphane Guillen, Maud Eugene, François Walker, Gregory Lun, Ronda Guenego, Adrien Consoli, Arturo Marnat, Gaultier Maier, Benjamin Lapergue, Bertrand Fahed, Robert |
description | 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.
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.
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.
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. |
doi_str_mv | 10.1161/STROKEAHA.120.030237 |
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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.
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.
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.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.120.030237</identifier><identifier>PMID: 34433309</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Arterial Occlusive Diseases - surgery ; Endovascular Procedures - methods ; Female ; Humans ; Ischemic Stroke - surgery ; Life Sciences ; Male ; Middle Aged ; Registries ; Thrombectomy - methods ; Treatment Outcome ; Vertebrobasilar Insufficiency - surgery</subject><ispartof>Stroke, 2021-12, Vol.52 (12), p.3777-3785</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4325-3727f8f2b34b8834ad87b2dc07811a8b2790e334b38a6391f1b60820b0c230c93</citedby><cites>FETCH-LOGICAL-c4325-3727f8f2b34b8834ad87b2dc07811a8b2790e334b38a6391f1b60820b0c230c93</cites><orcidid>0000-0001-8424-4464 ; 0000-0001-7281-1652 ; 0000-0002-1354-4328 ; 0000-0002-3975-3865 ; 0000-0002-6506-4019 ; 0000-0002-1887-5097 ; 0000-0002-0898-5022 ; 0000-0002-4344-9102 ; 0000-0001-8455-8201 ; 0000-0003-1891-9157 ; 0000-0002-0945-5656 ; 0000-0002-3384-0423 ; 0000-0001-6640-8541 ; 0000-0003-3993-1024 ; 0000-0002-7611-7753 ; 0000-0001-7367-8793</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,885,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34433309$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.univ-lille.fr/hal-04515125$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Aubertin, Mathilde</creatorcontrib><creatorcontrib>Weisenburger-Lile, David</creatorcontrib><creatorcontrib>Gory, Benjamin</creatorcontrib><creatorcontrib>Richard, Sébastien</creatorcontrib><creatorcontrib>Blanc, Raphael</creatorcontrib><creatorcontrib>Ducroux, Célina</creatorcontrib><creatorcontrib>Piotin, Michel</creatorcontrib><creatorcontrib>Labreuche, Julien</creatorcontrib><creatorcontrib>Lucas, Ludovic</creatorcontrib><creatorcontrib>Dargazanli, Cyril</creatorcontrib><creatorcontrib>Benali, Amel</creatorcontrib><creatorcontrib>Bourcier, Romain</creatorcontrib><creatorcontrib>Detraz, Lili</creatorcontrib><creatorcontrib>Vannier, Stéphane</creatorcontrib><creatorcontrib>Guillen, Maud</creatorcontrib><creatorcontrib>Eugene, François</creatorcontrib><creatorcontrib>Walker, Gregory</creatorcontrib><creatorcontrib>Lun, Ronda</creatorcontrib><creatorcontrib>Guenego, Adrien</creatorcontrib><creatorcontrib>Consoli, Arturo</creatorcontrib><creatorcontrib>Marnat, Gaultier</creatorcontrib><creatorcontrib>Maier, Benjamin</creatorcontrib><creatorcontrib>Lapergue, Bertrand</creatorcontrib><creatorcontrib>Fahed, Robert</creatorcontrib><creatorcontrib>ETIS Investigators</creatorcontrib><title>First-Pass Effect in Basilar Artery Occlusions: Insights From the Endovascular Treatment of Ischemic Stroke Registry</title><title>Stroke</title><addtitle>Stroke</addtitle><description>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.
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.
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.
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. 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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.
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.
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.
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.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>34433309</pmid><doi>10.1161/STROKEAHA.120.030237</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-8424-4464</orcidid><orcidid>https://orcid.org/0000-0001-7281-1652</orcidid><orcidid>https://orcid.org/0000-0002-1354-4328</orcidid><orcidid>https://orcid.org/0000-0002-3975-3865</orcidid><orcidid>https://orcid.org/0000-0002-6506-4019</orcidid><orcidid>https://orcid.org/0000-0002-1887-5097</orcidid><orcidid>https://orcid.org/0000-0002-0898-5022</orcidid><orcidid>https://orcid.org/0000-0002-4344-9102</orcidid><orcidid>https://orcid.org/0000-0001-8455-8201</orcidid><orcidid>https://orcid.org/0000-0003-1891-9157</orcidid><orcidid>https://orcid.org/0000-0002-0945-5656</orcidid><orcidid>https://orcid.org/0000-0002-3384-0423</orcidid><orcidid>https://orcid.org/0000-0001-6640-8541</orcidid><orcidid>https://orcid.org/0000-0003-3993-1024</orcidid><orcidid>https://orcid.org/0000-0002-7611-7753</orcidid><orcidid>https://orcid.org/0000-0001-7367-8793</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Aged Arterial Occlusive Diseases - surgery Endovascular Procedures - methods Female Humans Ischemic Stroke - surgery Life Sciences Male Middle Aged Registries Thrombectomy - methods Treatment Outcome Vertebrobasilar Insufficiency - surgery |
title | First-Pass Effect in Basilar Artery Occlusions: Insights From the Endovascular Treatment of Ischemic Stroke Registry |
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