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Original research
First pass effect of mechanical thrombectomy for acute vertebrobasilar artery occlusion: data from the ANGEL-ACT registry
  1. Dapeng Sun1,
  2. Xiaochuan Huo1,
  3. Raynald1,
  4. BaiXue Jia1,
  5. Xu Tong1,
  6. Anxin Wang2,
  7. Ning Ma1,
  8. Feng Gao1,
  9. Dapeng Mo1,
  10. Zhongrong Miao1
  11. on behalf of ANGEL-ACT study group
    1. 1 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    2. 2 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    1. Correspondence to Dr Zhongrong Miao, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; zhongrongm{at}; Dr Xiaochuan Huo, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; huoxiaochuan{at}


    Background To explore the incidence, predictors, and association of first pass effect (FPE) on clinical outcomes of mechanical thrombectomy (MT) for acute vertebrobasilar artery occlusion (VBAO) in the Asian population.

    Methods We selected patients from the ANGEL-ACT registry. We defined FPE as complete recanalization after one MT attempt without rescue treatment, multiple pass effect (MPE) as complete recanalization after >1 MT attempt or after one MT attempt with rescue treatment, and incomplete recanalization (ICR) as a modified Thrombolysis in Cerebral Ischemia score of 2b, independent of the number of MT attempts. We conducted multivariable logistic analyses to identify the independent predictors of FPE and to compare the outcomes, including favorable outcome, mortality within 90 days, and intracranial hemorrhage (ICH) among the FPE, MPE, and ICR groups.

    Results Two hundred and seventy-nine patients, 68 with FPE (24.4%), 114 with MPE (40.9%), and 83 with ICR (29.7%), were included. Underlying intracranial atherosclerosis disease (ICAD) (adjusted OR (aOR) 0.16, 95% CI 0.08 to 0.34, P<0.001) was independently associated with a low chance of FPE. Furthermore, FPE was associated with a favorable outcome compared with MPE and ICR (MPE vs FPE, aOR 0.49, 95% CI 0.25 to 0.97, P=0.040; ICR vs FPE, aOR 0.38, 95% CI 0.18 to 0.81, P=0.012), and decreased mortality (MPE vs FPE, aOR 2.57, 95% CI 1.04 to 6.36, P=0.041) compared with MPE but similar mortality to ICR (P=0.374). No difference was found for ICH among the three groups (P>0.05).

    Conclusions FPE occurred in 24.4% of patients with VBAO in our cohort, which was associated with improved clinical outcomes compared with MPE and ICR. VBAO with underlying ICAD was less likely to achieve FPE.

    Trial registration number NCT03370939.

    • stroke
    • thrombectomy

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    • Collaborators ANGEL-ACT study group: Liqiang Gui (Langfang Changzheng Hospital, Hebei, China); Cunfeng Song (Liaocheng Third People’s Hospital, Shandong, China); Ya Peng (The First People’s Hospital of Changzhou, Jiangsu, China); Jin Wu (Second Affiliated Hospital of Nanjing Medical University, Jiangsu, China); Shijun Zhao (Fengrun District People’s Hospital of Tangshan City, Hebei, China); Junfeng Zhao (SiPing Central People’s Hospital, Jilin, China); Zhiming Zhou (Yijishan Hospital of Wannan Medical College, Anhui, China); Yongli Li (The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China); Ping Jing (Central Hospital of Wuhan, Hubei, China); Lei Yang (First Hospital of Shijiazhuang, Hebei, China); Yajie Liu (Shenzhen Hospital of Southern Medical University, Guangdong, China); Qingshi Zhao (Longhua People’s Hospital, Guangdong, China); Yan Liu (Jingjiang People’s Hospital, Jiangsu, China); Xiaoxiang Peng (The Third People’s Hospital of Hubei Province, Hubei, China); Qingchun Gao (Second Affiliated Hospital of Guangzhou Medical University, Guangdong, China); Zaiyu Guo (Tianjin TEDA Hospital, Tianjin, China); Wenhuo Chen (Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China); Weirong Li (Taiyuan Central Hospital, Shanxi, China); Xiaojiang Cheng (First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China); Yun Xu (Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China); Yongqiang Zhang (Wenling First People’s Hospital, Zhejiang, China); Guilian Zhang (The Second Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China); Yijiu Lu (Yulin First People’s Hospital, Guangxi, China); Xinyu Lu (Zhenjiang First People’s Hospital, Jiangsu, China); Dengxiang Wang (Qitaihe Coal General Hospital Heilongjiang, China); Yan Wang (People’s Hospital of Tangshan City, Hebei, China); Hao Li (Affiliated Hospital of Guilin Medical University, Guangxi, China); Yang Hua (The Affiliated Hospital of Guizhou Medical University, Guizhou Province, China); Deqin Geng (The Affiliated Hospital of Xuzhou Medical University, Jiangsu, China); Haicheng Yuan (Qingdao Central Hospital, Shandong, China); Hongwei Wang (The Fourth People’s Hospital of Langfang City, Hebei, China); Haihua Yang (Beijing Daxing Hospital, Beijing, China); Zengwu Wang (Weifang People’s Hospital, Shandong, China); Liping Wei (Luoyang General Hospital Affiliated to Zhengzhou University, Henan, China); Xuancong Liufu (Dongguan Kanghua Hospital, Guangdong, China); Xiangqun Shi (Shunde Hospital of Southern Medical University, Guangdong, China); Juntao Li (Handan Central Hospital, Hebei, China); Wenwu Yang (The 981 Hospital of the Chinese People’s Liberation Army, Hebei, China); Wenji Jing (Linfen People’s Hospital, Shanxi, China); Xiang Yong (Anshun People’s Hospital of Guizhou, China); Leyuan Wang (Changle People’s Hospital, Shandong, China); Chunlei Li (The Second People’s Hospital of Dongying, Shandong, China); Yibin Cao (Tangshan Gongren Hospital, Hebei, China); Qingfeng Zhu (PLA 985 Hospital of the Joint Logistics Support Force, Shanxi, China); Peng Zhang (Gaomi People’s Hospital, Shandong, China); Xiang Luo (Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China); Shengli Chen (Chongqing Sanxia Center Hospital, Chongqing, China); WenWu Peng (Hospital of Traditional Chinese Medicine of Qiannan, Guizhou, China); Lixin Wang (Guangdong Hospital of Chinese Medicine, Guangdong, China); Xue Wen (People’s Hospital of Yangjiang, Guangdong, China); Shugui Shi (The Third Affiliated Hospital of CQMU, Chongqing, China); Wanming Wang (General Hospital of The Yangtze River Shipping, Hubei, China); Wang Bo (First People’s Hospital of Bijie City, Guizhou, China); Pu Yuan (Suqian People’s Hospital of Nanjing Drum-Tower Hospital Group, Jiangsu, China); Dong Wang (Weifang TCM Hospital, Shandong, China); Haitao Guan (Third Affiliated Hospital of Guangzhou Medical University, Guangdong, China); Wenbao Liang (Karamay Central Hospital, Xinjiang, China); Daliang Ma (Third People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China); Long Chen (Wulanchabu City Central Hospital, Inner Mongolia, China); Yan Xiao (Hospital of Xinjiang Production and Construction Corps, Xinjiang, China); Xiangdong Xie (Jiaozuo Second People’s Hospital, Henan, China); Zhonghua Shi (The 904 Hospital of Joint Logistic Support Force of PLA, Jiangsu, China); Xiangjun Zeng (Ganzhou People’s Hospital, Jiangxi, China); Fanfan Su (The 967 Hospital of the Joint Logistics Support Force of PLA, Liaoning, China); Mingze Chang (The Affiliated Hospital of Northwest University Xi’an No 3 Hospital, Shaanxi, China); Jijun Yin (The Second Hospital of Liao Cheng, Shandong, China); Hongxia Sun (Jilin Province People’s Hospital, Jilin, China); Chong Li (People’s Hospital of Huanghua City, Hebei, China); Yong Bi (Shanghai Forth People’s Hospital, Shanghai, China); Gang Xie (Wanbei Coal-Electricity Group General Hospital, Anhui, China); Yuwu Zhao (Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China); Chao Wang (Binzhou Medical University Hospital, Shandong, China); Peng Zhang (The 988 Hospital of the People’s Liberation Army, Henan, China); XianjunWang (Linyi People’s Hospital, Shandong, China); Dongqun Li (Yingkou City Central Hospital, Liaoning, China); Hui Liang (Yantaishan Hospital, Shandong, China); Zhonglun Chen (Mianyang Central Hospital, Sichuan, China); Yan Wang (Chengdu Fifth People’s Hospital, Sichuan, China); Yuxin Wang (Hengshui Fifth Hospital of Heng Shui City, Hebei, China); Lin Yin (Second Hospital of Dalian Medical University, Liaoning, China); HongKai Qiu (Boai Hospital of Zhongshan, Guangdong, China); Jun Wei (The First People’s Hospital of Yibin, Sichuan, China); Yaxuan Sun (Shanxi Provincial People’s Hospital, Shanxi, China); Xiaoya Feng (Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China); Weihua Wu (Chuxiong State People’s Hospital, Chuxiong, Yunnan, China); Lianbo Gao (The Fourth Affiliated Hospital of China Medical University, Liaoning, China); Zhibing Ai (Taihe Hospital, Shiyan, Hubei, China); Lan Tan (Qingdao Municipal Hospital, Shandong, China); Li Ding (First People’s Hospital of Yunnan Province, Yunnan, China); Qilong Liang (Lanzhou NO.2 People’s Hospital, Gansu, China); Zhimin Wang (Taizhou First People’s Hospital, Zhejiang, China); Jianwen Yang (Hunan Provincial People’s Hospital, Hunan, China); Ping Xu (First People’s Hospital of Changde City, Hunan, China); Wei Dong (Zhejiang Yuyao People’s Hospital, Zhejiang, China); Quanle Zheng (Aidebao Hospital, Hebei, China); Zhenyun Zhu (The First Hospital of Fangshan District, Beijing, China); Liyue Zhao (Tianjin Xiqing Hospital, Tianjin, China); Qingbo Meng (People’s Hospital of Zunhua, Hebei, China); Yuqing Wei (Xingtai Third Hospital, Hebei, China); Xianglin Chen (Qingyuan People’s Hospital, Guangdong, China); Wei Wang (Fengcheng City Central Hospital, Liaoning, China); Dong Sun (People’s Hospital of Hejian City, Hebei, China); Yongxing Yan (Hangzhou Third People’s Hospital, Zhejiang, China); Guangxiong Yuan (Xiangtan Central Hospital, Hunan, China); Yadong Yang (People’s Hospital of Nanpi Country, Hebei, China); Jianfeng Zhou (Liuzhou Railway Central Hospital, Guangxi, China); Zhi Yang (Maoming People’s Hospital, Guangdong, China); Zhenzhong Zhang (Tongde Hospital of Zhejiang Province, Zhejiang, China); Ning Guan (The First Affiliated Hospital of Jinzhou Medical University, Liaoning, China); Huihong Wang (Xishan Coal Electricity Group Worker General Hospital, Shaanxi, China).

    • Contributors ZM, XH, and DS were involved in the study conception. Statistical analysis was done by AW. The article was drafted by DS. All authors reviewed and approved the final article. Guarantors: ZM and XH.

    • Funding The ANGEL-ACT registry was funded by the National Key Research and Development Program of China, grant No 2016YFC1301500.

    • Competing interests None declared.

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

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