Key result
Multiple thrombectomy passes are linked to ~3.5-fold higher odds of worse 90-day disability vs a single pass.
Why the study?
First-pass success is associated with better outcomes in adult endovascular thrombectomy, but whether this first-pass effect holds true in childhood stroke was unknown.
Does the number of thrombectomy passes independently affect 90-day functional outcomes (mRS) or is the effect mediated through recanalisation quality in paediatric patients undergoing endovascular thrombectomy for acute ischaemic stroke?
Observational (n=103)
Yes
Does the number of thrombectomy passes independently affect 90-day functional outcomes (mRS) or is the effect mediated through recanalisation quality in paediatric patients undergoing endovascular thrombectomy for acute ischaemic stroke?
In paediatric mechanical thrombectomy for acute ischaemic stroke, the apparent association between multiple passes and worse 90-day functional outcomes is largely mediated by final recanalisation quality (eTICI grade) rather than an independent harmful effect of additional passes.
Multiple passes link to worse paediatric mRS only via recanalisation quality; supports eTICI-focused strategies but leaves independent effects open.
Introduction In adult endovascular thrombectomy (EVT), first-pass success is associated with better outcomes, but whether this “first-pass effect” also holds true in childhood stroke remains unknown. We investigated the association of thrombectomy pass counts with 90-day outcomes after paediatric EVT. Patients and methods We analysed prospectively collected data from the international Save ChildS Pro registry (ages 0–17 years). All EVT-treated patients were included irrespective of the reperfusion grade achieved. Successful reperfusion was defined as expanded thrombolysis in cerebral infarction (eTICI) ≥ 2b and complete/near-complete reperfusion as eTICI 2c–3. The primary outcome was ordinal 90-day mRS in a proportional odds model. Single-pass and multiple-pass patients were then compared with each other within the subgroup achieving eTICI 2c–3. Logistic regression for mRS > 2 was fitted with pass count and eTICI grade as covariates. Results Of 103 patients (median age 11 years [IQR 6–15]; 55/102 [53.9%] male), median passes were 2 (IQR 1–3); 39 (37.9%) had 1 pass, 61 (59.2%) more than 1 and 3 (2.9%) recanalised without a thrombectomy pass. Multiple passes were associated with lower eTICI 2c–3 rates (30.0% vs 82.1%; P < .001), and worse 90-day mRS (common odds ratio 3.47; 95% CI, 1.63–7.38; P = .001). However, among patients achieving eTICI 2c–3 (n = 50), we detected no difference by pass count (mRS 0–2: 93.8% vs 94.4%; risk difference − 0.6%, 95% CI, −15% to +20%; P = 1.000). After accounting for eTICI, pass count was not independently associated with mRS > 2, while eTICI remained significant. Conclusions In this analysis of the first-pass effect in paediatric thrombectomy, multiple passes were associated with worse functional outcomes, but this effect appeared to be largely mediated through recanalisation quality. Subgroup analyses were underpowered to exclude a clinically relevant residual effect of pass count, and these findings should be considered hypothesis-generating.
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Dmytriw et al. (2026) conducted an observational in Paediatric acute ischaemic stroke treated with endovascular thrombectomy (n=103). Multiple thrombectomy passes (>1 pass) vs. Single thrombectomy pass (1 pass) was evaluated on Ordinal 90-day modified Rankin Scale (mRS) score (OR 3.47, 95% CI 1.63-7.38, p=0.001). Multiple thrombectomy passes were associated with worse 90-day ordinal mRS compared to a single pass (OR 3.47, P=0.001), an effect mediated by recanalisation quality.
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