Key result
Thrombectomy time ≤30 minutes linked to ~72% higher odds of 30-day functional independence.
Why the study?
The clinical benefit of achieving modified first-pass effect during mechanical thrombectomy for large-vessel occlusion stroke may be time-sensitive. Whether procedural duration exerts a continuous, dose-dependent effect on clinical outcomes among patients achieving modified first-pass effect required assessment.
Does shorter procedural time (≤30 minutes) improve 30- and 90-day functional independence in acute ischemic stroke patients achieving modified first-pass effect after mechanical thrombectomy?
Cohort (n=417)
Yes
Does shorter procedural time (≤30 minutes) improve 30- and 90-day functional independence in acute ischemic stroke patients achieving modified first-pass effect after mechanical thrombectomy?
Even among stroke patients achieving technically successful single-pass reperfusion (mFPE), keeping procedural time ≤30 minutes is independently associated with better 30-day functional independence and shorter hospital length of stay, though the functional benefit attenuates by 90 days.
Answers are grounded in this paper and cite their sources.
Shorter procedural time associated with 30-day independence after first-pass thrombectomy; leaves open 90-day benefit and need for prospective validation.
BACKGROUND: Modified first-pass effect (mFPE) is an established benchmark of mechanical thrombectomy (MT) success in large-vessel occlusion (LVO) stroke, yet its clinical benefit may be time sensitive. Prior studies indicate that procedural time (PT) exceeding 30 minutes carries higher complications rates and worse outcomes. We assessed whether procedural duration exerts a continuous, dose-dependent effect on clinical outcomes among patients achieving mFPE. METHODS: This multicenter, retrospective study analyzed patients who achieved mFPE after MT for acute ischemic stroke between February 2018 and March 2024. Primary outcomes were 30- and 90-day functional independence (modified Rankin Scale score 0-2). Secondary outcomes included length of stay (LOS), symptomatic intracranial hemorrhage (sICH), and mortality. Multivariate logistic regression models evaluated associations between PT (modeled continuously and dichotomized by a 30-minute cut-off) and clinical outcomes. RESULTS: Among 417 patients achieving mFPE, 302 (72.4%) had PT ≤30 minutes. Shorter PT was independently associated with functional independence at 30 days (aOR 1.72, 95% CI 1.06-2.80; p=0.03) but not at 90 days (aOR 1.44, 95% CI 0.89-2.32; p=0.14). Modeled continuously within each time window, PT showed no significant association with functional independence, although ordinal analysis suggested worse mRS with longer PT only in the >30-minute group at 30 days (aOR 1.18; p=0.04). Median LOS was shorter for PT ≤30 minutes (6 (3-10) vs. 7 (4-13) days, p=0.01). sICH and mortality did not differ by PT. CONCLUSION: Among patients achieving mFPE, shorter PT remained independently associated with better functional outcomes at 30 days, but not at 90 days, with no significant gradient within either window, supporting the importance of procedural efficiency even after technically successful single-pass reperfusion.
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Otamendi-Lopez et al. (2026) conducted a cohort in Acute ischemic stroke with large-vessel occlusion (LVO) (n=417). Procedural time ≤30 minutes during mechanical thrombectomy vs. Procedural time >30 minutes was evaluated on 30- and 90-day functional independence (modified Rankin Scale score 0-2) (aOR 1.72, 95% CI 1.06-2.80, p=0.03). Procedural time ≤30 minutes was independently associated with 30-day functional independence after first-pass reperfusion, though not at 90 days.
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