Per-pass analysis of recanalization and good neurological outcome in thrombectomy for stroke: Systematic review and meta-analysis. Issue 3 (June 2022)

• Record Type: Journal Article
• Authors: Arturo Larco, Jorge; Abbasi, Mehdi; Liu, Yang; Madhani, Sarosh Irfan; Shahid, Adnan Hussain; Kadirvel, Ramanathan; Brinjikji, Waleed; Savastano, Luis E
• Is Part Of: Interventional neuroradiology. Volume 28:Issue 3(2022)
• Page Start: 358
• Page End: 363
• Publication Date: 2022-06
• Subjects: Ischemic stroke -- thrombectomy -- per pass -- mRS 0-2 at 90 days -- good neurological outcome; Nervous system -- Interventional radiology -- Periodicals; Nervous system -- Radiography -- Periodicals; Nervous System Diseases -- Periodicals -- radiography; Neuroradiography -- Periodicals; Radiography, Interventional -- Periodicals; Nervous system -- Radiography; Periodicals; 617.4805
• DOI: 10.1177/15910199211028342
• Languages: English
• ISSNs: 1591-0199

Abstract

Background and aim: First pass effect (FPE) is defined as achieving a complete recanalization with a single thrombectomy device pass. Although clinically desired, FPE is reached in less than 30% of thrombectomy procedures. Multiple device passes are often necessary to achieve successful or complete recanalization. We performed a systematic review and meta-analysis to determine the recanalization rate after each pass of mechanical thrombectomy and its association with good neurological outcome. Methods: A literature search was performed for studies reporting the number of device passes required for either successful (mTICI 2b or higher) or complete (mTICI 2c or higher) recanalization. Using random-effect meta-analysis, we evaluated the likelihood of recanalization and good neurological outcome (measured with the modified Rankin Score <2 at 90 days) after each device pass. Results: Thirteen studies comprising 4197 patients were included. Among cases with failed first pass, 24% of them achieved final complete recanalization and 45% of them achieved final successful recanalization. Independently to the total number of previously failed attempts, the likelihood of achieving successful recanalization was 30% per pass, and the likelihood to achieve complete recanalization was about 20% per pass. The likelihood of good neurological outcome in patients with final successful recanalization decreased after each device pass: 55% after the first pass, 48% after the second pass, 42% after the third pass, 36% after the fourth pass, and 26% for 5 passes or more. Conclusion: Each pass is associated with a stable likelihood of recanalization but a decreased likelihood of good neurological outcome.