Effect of first-pass reperfusion on outcome after endovascular treatment for ischemic stroke

Sanne J. Den Hartog*, Osama Zaidat, MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry Investigators, Bob Roozenbeek, Adriaan C.G.M. van Es, Agnetha A.E. Bruggeman, Bart J. Emmer, Charles B.L.M. Majoie, Wim H. van Zwam, Ido R. van den Wijngaard, Pieter Jan van Doormaal, Hester F. Lingsma, James F. Burke, Diederik W.J. Dippel

*Corresponding author for this work

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Abstract

BACKGROUND: First-pass reperfusion (FPR) is associated with favorable outcome after endovascular treatment. It is unknown whether this effect is independent of patient characteristics and whether FPR has better outcomes compared with excellent reperfusion (Expanded Thrombolysis in Cerebral Infarction [eTICI] 2C-3) after multiple-passes reperfusion. We aimed to evaluate the association between FPR and outcome with adjustment for patient, imaging, and treatment characteristics to single out the contribution of FPR. METHODS AND RESULTS: FPR was defined as eTICI 2C-3 after 1 pass. Multivariable regression models were used to investigate characteristics associated with FPR and to investigate the effect of FPR on outcomes. We included 2686 patients of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. Factors associated with FPR were as follows: history of hyperlipidemia (adjusted odds ratio [OR], 1.05; 95% CI, 1.01–1.10), middle cerebral artery versus intracranial carotid artery occlusion (adjusted OR, 1.11; 95% CI, 1.06–1.16), and aspiration versus stent thrombectomy (adjusted OR, 1.07; 95% CI, 1.03–1.11). Interventionist experience increased the likelihood of FPR (adjusted OR, 1.03 per 50 patients previously treated; 95% CI, 1.01–1.06). Adjusted for patient, imaging, and treatment characteristics, FPR remained associated with a better 24-hour National Institutes of Health Stroke Scale (NIHSS) score (−37%; 95% CI, −43% to −31%) and a better modified Rankin Scale (mRS) score at 3 months (adjusted common OR, 2.16; 95% CI, 1.83–2.54) compared with no FPR (multiple-passes reperfusion+no excellent reperfusion), and compared with multiple-passes reperfusion alone (24hour NIHSS score, (−23%; 95% CI, −31% to −14%), and mRS score (adjusted common OR, 1.45; 95% CI, 1.19–1.78)). CONCLUSIONS: FPR compared with multiple-passes reperfusion is associated with favorable outcome, independently of patient, imaging, and treatment characteristics. Factors associated with FPR were the experience of the interventionist, history of hyperlipidemia, location of occluded artery, and use of an aspiration device compared with stent thrombectomy.

Original languageEnglish
Article numbere019988
JournalJournal of the American Heart Association
Volume10
Issue number7
DOIs
Publication statusPublished - 6 Apr 2021

Bibliographical note

Funding Information:
The MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke) Registry was partly funded by Stichting Toegepast Wetenschappelijk Instituut voor Neuromodulatie, Erasmus MC, University Medical Center, Maastricht University Medical Center, and Amsterdam University Medical Center.

Publisher Copyright: © 2021 The Authors.

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