First-pass effect during stent retriever thrombectomy for acute basilar artery occlusion was strongly associated with a 90-day favorable outcome (adjusted OR 2.84; 95% CI 1.56-5.16; p=0.001).
Cohort (n=471)
Does achieving a first-pass effect improve favorable functional outcomes in patients with acute basilar artery occlusion undergoing stent retriever thrombectomy?
Achieving a first-pass effect during stent retriever thrombectomy for acute basilar artery occlusion is independently associated with significantly higher rates of 90-day favorable functional outcomes and lower mortality.
Estimación del efecto: adjusted OR 2.84 (95% CI 1.56-5.16)
valor p: p=0.001
OBJECTIVE: First-pass effect (FPE), defined as successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b-3) with a single stent retriever attempt without salvage treatment, has not been fully identified in patients with acute basilar artery occlusion (BAO). The authors' aim was to assess the impact of FPE on efficacy and safety for patients with BAO. METHODS: The authors included data from the Acute Basilar Artery Occlusion Study (BASILAR) about patients who underwent mechanical thrombectomy within 24 hours after symptom onset and compared the clinical outcomes of patients who achieved FPE with those who did not. In addition, the authors further compared outcomes between patients with FPE and those with final successful reperfusion achieved with salvage treatment. The primary clinical outcome was favorable outcome (modified Rankin Scale score ≤ 3). RESULTS: Among 471 enrolled patients, FPE was achieved in 83 (17.6%) who underwent acute BAO thrombectomy. FPE was strongly associated with favorable outcome (adjusted OR 2.84, 95% CI 1.56-5.16, p = 0.001), lower rate of mortality (28.9% of FPE patients vs 48.2% of non-FPE patients, p = 0.001), and shorter median time from groin puncture to recanalization (65 minutes vs 110 minutes, p < 0.001). Occlusion site of the distal basilar artery, cardioembolism, and undetermined etiology were positive predictors of FPE, whereas baseline National Institutes of Health Stroke Scale score was a negative predictor. Compared with final successful reperfusion, FPE also contributed independently to favorable outcomes (adjusted OR 2.25, 95% CI 1.23-4.10, p = 0.008). CONCLUSIONS: FPE was associated with 90-day favorable outcome in patients with acute BAO who underwent stent retriever thrombectomy within 24 hours. Clinical trial registration no.: ChiCTR1800014759 (www.chictr.org.cn).
Zhao et al. (Fri,) conducted a cohort in Acute basilar artery occlusion (BAO) (n=471). First-pass effect (FPE) during stent retriever thrombectomy vs. Non-FPE was evaluated on Favorable outcome (modified Rankin Scale score ≤ 3) (adjusted OR 2.84, 95% CI 1.56-5.16, p=0.001). First-pass effect during stent retriever thrombectomy for acute basilar artery occlusion was strongly associated with a 90-day favorable outcome (adjusted OR 2.84; 95% CI 1.56-5.16; p=0.001).