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Original research
Beyond the first pass: revascularization remains critical in stroke thrombectomy
  1. Gaurav Jindal,
  2. Helio De Paula Carvalho1,
  3. Aaron Wessell2,
  4. Elizabeth Le2,
  5. Varun Naragum1,
  6. Timothy Ryan Miller1,
  7. Marcella Wozniak3,
  8. Ravi Shivashankar1,
  9. Carolyn A Cronin3,
  10. Chad Schrier3,
  11. Dheeraj Gandhi1
  1. 1 Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA
  2. 2 Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
  3. 3 Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
  1. Correspondence to Dr Gaurav Jindal, Division of Interventional Neuroradiology University of Maryland Medical Center, Baltimore, Maryland, USA ; drjindal{at}


Background The first pass effect has been recently reported as a predictor of good clinical outcome after stroke thrombectomy. We evaluate the first pass effect on outcome and the influence of revascularization in these and other patients.

Methods We performed a retrospective analysis of a prospectively maintained database on anterior cerebral circulation stroke thrombectomy cases from April 2012 to April 2018. Data compiled included patient demographics, presenting National Institutes of Health Stroke Scale score, vessel occlusion site, thrombectomy procedural details, and 90 day modified Rankin Scale scores.

Results 205 patients were included. The numbers of patients who underwent one, two, three, four, five, and six passes were 69, 70, 55, 9, 1, and 1, respectively. Successful revascularization was achieved in 87%, 83%, and 64% of patients in the one, two, and 3 or more passes groups, respectively (p=0.002). Good functional outcome was inversely correlated with number of passes when comparing the one, two, and three or more passes groups (54%, 43%, 29%; P=0.014). In patients with full revascularization, there was no significant difference in good functional outcomes between the one, two, and three or more passes groups (64%, 65%, 50%; P=0.432). Number of passes was not an independent negative predictor of good clinical outcome (OR 1.66, 95% CI 0.82 to 3.39; P=0.165).

Conclusions First pass thrombectomy patients have better functional outcomes compared with beyond-first pass patients. This effect is related at least in part to a higher rate of revascularization in one pass patients. Revascularization beyond the first pass should continue to be the goal of stroke thrombectomy.

  • thrombectomy
  • technique
  • stroke
  • stent

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  • Contributors All authors contributed to data collection, manuscript preparation, and/or review. GJ is the guarantor of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests GJ has research grant funding from Stryker Neurovascular and Microvention not directly related to the work presented here.

  • Ethics approval Local institutional review board approval was obtained for data collection and analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice Since this paper was first published online, minor changes have been made to tables 2 and 3.

  • Patient consent for publication Not required.