WSO - February 2023 - 221

1089772
WSO
International Journal of Stroke X(X)Terceño et al.
Research
First pass effect in posterior circulation
occlusions: Analysis from the CICAT
registry
Mikel Terceño1,2 , Yolanda Silva1, Saima Bashir1,
Ángel Chamorro3 , Natalia Pérez de la Ossa4,5,
María Hernandez-Pérez4 , Carlos Castaño2,
Pol Camps-Renom6 , Denisse Wenger4, Pere Cardona7,
Carlos Molina8, Ana Rodríguez-Campello9, David Cánovas10,
Francisco Purroy11 , Mercè Salvat-Plana12 and
Joaquín Serena1; on behalf of the Catalan Stroke Code and
Reperfusion Consortium (Cat-SCR)
Abstract
Background: The first pass effect (FPE) is an independent predictor of functional independence in patients with large
vessel occlusion in anterior circulation ischemic strokes. However, whether it predicts outcome in posterior circulation
large vessel occlusion (PC-LVO) is uncertain. We aimed to study the frequency, characteristics, and predictors of FPE
and its association with clinical outcomes in PC-LVO.
Method: We performed an analysis from the prospective CICAT Registry. All patients with PC-LVO who underwent
endovascular therapy between January 2016 and January 2020 were included. A centrally assessed clinical follow-up was
performed at 3 months by blinded investigators. FPE was defined as the achievement of modified Thrombolysis In Cerebral
Infarction 3 in a single pass of the endovascular thrombectomy device, and multi-pass effect (MPE) if it was achieved
in more than one pass. A multivariable analysis was performed to identify whether FPE is an independent predictor of
functional independence defined as a modified Rankin Score of 0-2.
Results: We analyzed data from 265 patients in who FPE was achieved in 105 (39.6%). Patients with FPE were more
likely to achieve functional independence compared to the non-FPE group (52.4% vs 25.1%, p < .001) and the MPE group
(52.4% vs 26.7%, p < .001). FPE was independently associated with functional independence (adjusted odds ratio (aOR):
2.10, 95% confidence interval (CI) 1.01-4.37) but MPE was not (aOR: 0.92, 95% CI 0.40-2.13). Independent predictors
of FPE were the use of direct aspiration, embolic mechanism of stroke, and the absence of general anesthesia (GA) use.
Conclusions: FPE is an independent predictor of functional independence in PC-LVO and was associated with a significantly
better outcome than MPE.
1Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
2Interventional Neuroradiology Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
3Stroke Unit, Department of Neurology, Clinic Hospital, Barcelona, Spain
4Stroke Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
5Stroke Program/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
6Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
7Stroke Unit, Department of Neurology, Bellvitge Hospital, Barcelona, Spain
8Stroke Unit, Department of Neurology, Vall d'Hebron Hospital, Barcelona, Spain
9Stroke Unit, Department of Neurology, Mar Hospital, Barcelona, Spain
10Stroke Unit, Department of Neurology, Parc Taulí Hospital, Sabadell, Spain
11Stroke Unit, Department of Neurology, Arnau de Vilanova Hospital, IRBLleida, University of Lleida, Lleida, Spain
12Catalan Stroke Programme, Catalan Public Health Department, Barcelona, Spain
Corresponding author:
Mikel Terceño, Unitat d'Ictus, Servei de Neurologia, Hospital Universitari Doctor Josep Trueta de Girona, Av de França s/n, Girona 17007, Spain.
Email: mterceno.girona.ics@gencat.cat
International Journal of Stroke, 18(2)
https://doi.org/10.1177/17474930221089772
International Journal of Stroke
2023, Vol. 18(2) 221 -228
© 2022 World Stroke Organization
Article reuse guidelines:
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DOI: 10.1177/17474930221089772
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