First pass effect as an independent predictor of functional outcomes in medium vessel occlusions: An analysis of an international multicenter study
Authors: Radu Răzvan Alexandru , Costalat Vincent , Fahed Robert , Ghozy Sherief , Siegler James E , Shaikh Hamza , Khalife Jane , Abdalkader Mohamad , Klein Piers , Nguyen Thanh N , Heit Jeremy J , Sweid Ahmad , El Naamani Kareem , Regenhardt Robert W , Diestro Jose Danilo Bengzon , Cancelliere Nicole M , Amllay Abdelaziz , Meyer Lukas , Dusart Anne , Bellante Flavio , Forestier Géraud , Rouchaud Aymeric , Saleme Suzana , Mounayer Charbel , Fiehler Jens , Kühn Anna Luisa , Puri Ajit S , Dyzmann Christian , Kan Peter T , Colasurdo Marco , Marnat Gaultier , Berge Jérôme , Barreau Xavier , Sibon Igor , Nedelcu Simona , Henninger Nils , Kyheng Maéva , Marotta Thomas R , Stapleton Christopher J , Rabinov James D , Ota Takahiro , Dofuku Shogo , Yeo Leonard LL , Tan Benjamin YQ , Martinez-Gutierrez Juan Carlos , Salazar-Marioni Sergio , Sheth Sunil , Renieri Leonardo , Capirossi Carolina , Mowla Ashkan , Tjoumakaris Stavropoula I , Jabbour Pascal , Khandelwal Priyank , Biswas Arundhati , Clarençon Frédéric , Elhorany Mahmoud , Premat Kevin , Valente Iacopo , Pedicelli Alessandro , Pedro Filipe João , Varela Ricardo , Quintero-Consuegra Miguel , Gonzalez Nestor R , Möhlenbruch Markus A , Jesser Jessica , Tancredi Illario , ter Schiphorst Adrien , Yedavalli Vivek , Harker Pablo , Chervak Lina M , Aziz Yasmin , Gory Benjamin , Paul Stracke Christian , Hecker Constantin , Killer-Oberpfalzer Monika , Griessenauer Christoph J , Thomas Ajith J , Hsieh Cheng-Yang , Liebeskind David S , Alexandre Andrea M , Faizy Tobias D , Weyland Charlotte , Patel Aman B , Pereira Vitor Mendes , Lubicz Boris , Dmytriw Adam A , Guenego Adrien 
Published: October 2023

Introduction: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. Patients and Methods: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0–2 at 3 months. Results: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10–2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93–0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59–3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25–0.72) and 0.55 (95% CI, 0.39–0.77), respectively. Conclusion: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.