First-Pass Effect in Basilar Artery Occlusions: Insights From the Endovascular Treatment of Ischemic Stroke Registry
Authors: Aubertin Mathilde , Weisenburger-Lile David , Gory Benjamin , Richard Sébastien , Blanc Raphael , Ducroux Célina , Piotin Michel , Labreuche Julien , Lucas Ludovic , Dargazanli Cyril , Benali Amel , Bourcier Romain , Detraz Lili , Vannier Stéphane , Guillen Maud , Eugene François , Walker Gregory , Lun Ronda , Guenego Adrien , Consoli Arturo , Marnat Gaultier , Maier Benjamin , Lapergue Bertrand , Fahed Robert , Piotin Michel , Blanc Raphael , Redjem Hocine , Escalard Simon , Desilles Jean-Philippe , Ciccio Gabriele , Smajda Stanislas , Maier Benjamin , Hebert Solene , Delvoye François , Mazighi Mikael , Obadia Mikael , Sabben Candice , Peres Roxanne , Corabianu Ovide , de Broucker Thomas , Smadja Didier , Alamowitch Sonia , Ille Olivier , Manchon Eric , Garcia Pierre-Yves , Taylor Guillaume , Ben Maacha Malek , Wang Adrien , Evrard Serge , Tchikviladze Maya , Ajili Nadia , Lapergue Bertrand , Weisenburge-Lile David , Gorza Lucas , Buard Géraldine , Coskun Oguzhan , Consoli Arturo , Di Maria Federico , Rodesch Georges , Zimatore Sergio , Leguen Morgan , Gratieux Julie , Pico Fernando , Rakotoharinandrasana Haja , Tassan Philippe , Poll Roxanna , Marinier Sylvie , Marnat Gaultier , Gariel Florent , Barreau Xavier , Berge Jérôme , Veunac Louis , Menegon Patrice , Sibon Igor , Lucas Ludovic , Olindo Stéphane , Renou Pauline , Sagnier Sharmila , Poli Mathilde , Debruxelles Sabrina , Bourcier Romain , Detraz Lili , Daumas-Duport Benjamin , Alexandre Pierre-Louis , Roy Monica , Lenoble Cédric , L’allinec, Vincent , Girot Jean-Baptiste , Desal Hubert , Gory Benjamin , Bracard Serge , Anxionnat René , Braun Marc , Derelle Anne-Laure , Tonnelet Romain , Liao Liang , Zhu François , Schmitt Emmanuelle , Planel Sophie , Richard Sébastien , Humbertjean Lisa , Mione Gioia , Lacour Jean-Christophe , Bonnerot Mathieu , Riou-Comte Nolwenn , Costalat Vincent , Arquizan Caroline , Dargazanli Cyril , Gascou, Grégory , Lefèvre Pierre-Henri , Derraz Imad , Riquelme Carlos , Gaillard Nicolas , Mourand Isabelle , Corti Lucas , Francois Eugene , Vannier Stéphane , Ferre Jean-Christophe , Raoult Helene , Ronziere Thomas , Lassale Maria , Paya Christophe , Gauvrit Jean-Yves , Tracol Clément , Langnier-Lemercier Sophie 
Published: August 2021

Background and Purpose:
In the settings of thrombectomy, the first-pass effect (FPE), defined by a complete recanalization after one pass with no rescue therapy, has been shown to be associated with an improved outcome. As this phenomenon has been predominantly described in anterior circulation strokes, we aimed to study the prevalence, outcomes, and predictors of FPE in patients with a basilar artery occlusion.

Methods:
From a prospective multicentric registry, we collected the data of all consecutive basilar artery occlusion patients who underwent thrombectomy and compared the outcomes of patients who achieved FPE and those who did not. We also compared FPE patients with those who achieved a complete recanalization with >1 pass. Finally, a multivariate analysis was performed to determine the predictors of FPE.

Results:
Data from 280 patients were analyzed in our study, including 84 of 280 patients (30%) with an atheromatous etiology. An FPE was achieved in 93 patients (33.2%), with a significantly higher proportion of good outcomes (modified Rankin Scale score 0-2 at 3 months) and lower mortality than non-FPE patients. An FPE was also associated with improved outcomes compared with patients who went on to have full recanalization with >1 pass. Contact aspiration as first-line strategy was a strong predictor of FPE, whereas baseline antiplatelets and atheromatous etiology were negative predictors.

Conclusions:
In our study, an FPE was achieved in approximately one-third of patients with a basilar artery occlusion and was associated with improved outcomes. More research is needed to improve devices and techniques to increase the incidence of FPE.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03776877.