Key result
Each additional EVT pass was associated with worse 90-day mRS, while first-pass reperfusion reduced 24-hour infarct volume.
Why the study?
Reperfusion success after EVT and the number of EVT passes may be associated with clinical and imaging outcomes in patients with acute stroke due to Medium Vessel Occlusion (MeVO).
Does first pass near-complete reperfusion or the number of EVT passes affect 90-day modified Rankin Score, 24-hour NIHSS, and 24-hour infarct volume in patients undergoing thrombectomy for MeVO stroke?
Cohort (n=206)
Does first pass near-complete reperfusion or the number of EVT passes affect 90-day modified Rankin Score, 24-hour NIHSS, and 24-hour infarct volume in patients undergoing thrombectomy for MeVO stroke?
In MeVO stroke thrombectomy, achieving first-pass near-complete reperfusion reduces 24-hour infarct volume and improves early neurological deficits, whereas an increasing number of thrombectomy passes is associated with worse 90-day functional outcomes.
Answers are grounded in this paper and cite their sources.
Additional passes associated with worse 90-day mRS in MeVO; hypothesis-generating for first-pass strategies before practice change.
BACKGROUND AND PURPOSE: Reperfusion success after EVT and the number of EVT passes may be associated with clinical and imaging outcomes in patients with acute stroke due to Medium Vessel Occlusion (MeVO). MATERIAL AND METHODS: Secondary analysis of patients randomized to EVT in the ESCAPE-MeVO trial. Final reperfusion was assessed with the MeVO-expanded Thrombolysis in Cerebral Infarction (MeVO-eTICI) Score. First pass near-complete reperfusion was defined as MeVO-eTICI 2c-3 after 1 pass and multi-pass near-complete reperfusion as MeVO-eTICI 2c-3 after >1 pass. The primary outcome was the modified Rankin Score (mRS) at 90 days. Secondary outcomes included 24-hour NIHSS and 24-hour infarct volume, among others. Associations were assessed using regression models. RESULTS: Of 255 patients randomized to EVT (48.3%), 206 remained for the final analysis. First pass near-complete reperfusion was associated with decreased infarct volume (median 12.8ml [IQR 0.15-25.3] versus: 22.4ml [6.71-56.38ml], adjusted beta-coefficient -1.68 [95%CI::-2.54-(-0.81)]) and improved 24-hour NIHSS (median 7 [2-13.5] versus: 2.5 [1-6.5], adjusted beta-coefficient -0.56 [95%CI:-0.74-(-0.38)]), but not with clinical outcomes. Similarly, improved reperfusion status was associated with lower infarct volumes and improved 24-hour NIHSS but not with clinical outcomes. Number of EVT passes was associated with higher 90-day mRS (acOR 1.41 [95%CI: 1.04-1.91] per 1-additional pass), higher 24-hour NIHSS and larger infarct volume. CONCLUSIONS: Improved first-pass reperfusion with EVT in MeVO stroke patients was associated with reduced infarct volumes and improved 24-hour NIHSS. Performing more EVT passes was associated with increased infarct volume and poorer 24-hour and 90-day outcomes.
No takes yet. Share an insight, caveat, or question.
Stebner et al. (2026) conducted a cohort in Acute stroke due to Medium Vessel Occlusion (MeVO) (n=206). First pass near-complete reperfusion (MeVO-eTICI 2c-3 after 1 pass) and number of EVT passes vs. Multi-pass near-complete reperfusion (MeVO-eTICI 2c-3 after >1 pass) or fewer EVT passes was evaluated on Modified Rankin Score (mRS) at 90 days (acOR 1.41 per 1-additional pass, 95% CI 1.04-1.91). Each additional EVT pass was associated with worse 90-day mRS, while first-pass reperfusion reduced 24-hour infarct volume.
Synapse has enriched 10 related papers. Consider them for comparative context: