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Impact of first pass effect in endovascular treatment of large core stroke: a post-hoc analysis of the ANGEL-ASPECT trial
      1. 1Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
      2. 2Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
      3. 3Department of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA
      4. 4China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
      5. 5Department of Neuroscience, Mercy Saint Vincent Medical Center, Toledo, Ohio, USA
      6. 6Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
      1. Correspondence to Dr Zhiming Zhou, Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, China; neuro_depar{at}hotmail.com; Dr Xiaochuan Huo, Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, Beijing 100070, China; huoxiaochuan{at}126.com

      Abstract

      Background The first-pass effect (FPE) is linked to better safety and efficacy prognosis in patients with small- to- moderate sized ischemic infarctions. We evaluated the incidence, prognosis, and predictors of FPE in patients with large core infarctions (LCIs).

      Methods We conducted a post-hoc analysis of data from the Trial of Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core (ANGEL-ASPECT). The FPE was defined as a successful recanalization (expanded Thrombolysis in Cerebral Infarction (eTICI) 2 c/3, and eTICI 2b-3 as modified FPE (mFPE)) after one pass. The primary outcome was clinical functional independence, and the secondary outcomes were independent ambulation, assessed by the modified Rankin Scale (mRS) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) defined by the Heidelberg bleeding classification, any intracranial hemorrhage (ICH), and death within 90 days of stroke onset.

      Results Of the 226 patients in the study, FPE and mFPE were achieved in 33 (14.6%) and 82 (36.3%) patients, respectively. Patients with FPE exhibited shorter onset-to-puncture times (adjusted odds ratio [OR] 0.915; 95% confidence interval [CI]: 0.84 to 0.996), and patients with mFPE were older (OR 1.039; 95% CI: 1.005 to 1.075). mFPE was significantly associated with favorable outcomes (modified Rankin score [mRS] 0–2: OR 2.64; 95% CI: 1.37 to 5.07; mRS 0–3: OR 3.31; 95% CI: 1.73 to 6.33). FPE tended to improve outcomes (mRS 0–3: OR 2.24; 95% CI: 0.92 to 4.97; p=0.08). ICH rates (OR 0.60; 95% CI: 0.34 to 1.05; p=0.07) and 90-day deaths (OR 0.57; 95% CI: 0.30 to 1.09; p=0.09) tended to decrease in patients who achieved mFPE but not in patients who achieved FPE.

      Conclusions In the ANGEL-ASPECT trial, patients who achieved mFPE had a higher rate of independent ambulation and functional independence, and the rates of any ICH and 90-day death tended to decrease.

      • 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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      Footnotes

      • X @NguyenThanhMD

      • XH and DS contributed equally.

      • Collaborators The ANGEL-ASPECT Study Group: Miao Zhongrong (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Ren Zeguang (University of south Florida, Tampa General Hospital, United States of America; Department of Neurosurgery); Vitor Mendes Pereira (St. Michael's Hospital, Toronto, Canada; Division of Neurosurgery, Department of Surgery); Huo Xiaochuan (Beijing Anzhen Hospital, Capital Medical University; Cerebrovascular Disease Department, Neurological Disease Center); Ma Gaoting (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Tong Xu (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Zhang Xuelei (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Sun Dapeng (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Liu Zhenqiang (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Yang Ming (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Zhang Yupeng (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Nie Ximing (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Wei Na (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Yang bo (Beijing Tiantan Hospital, Capital Medical University; Department of Interventional Neuroradiology); Meng Xia (Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases; Center of Neurology); Pan Yuesong (Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases; China National Clinical Research Center for Neurological Diseases); Wang Anxin (Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases; China National Clinical Research Center for Neurological Diseases); Liu Liping (Beijing Tiantan Hospital, Capital Medical University; Department of Neurology); Wang Yilong (Beijing Tiantan Hospital, Capital Medical University; Department of Neurology); Wang Yongjun (Beijing Tiantan Hospital, Capital Medical University; Department of Neurology); Ji Xunming (Capital Medical University, Xuanwu Hospital; Department of Neurosurgery); Liu Xinfeng (University of Science and Technology of China; Department of Neurology); Dong Qiang (Huashan Hospital Affiliated to Fudan University; Department of Neurology); Xu Anding (Guangzhou Overseas Chinese Hospital, the First Affiliated Hospital of Jinan University; Department of Neurology); Yang Qingwu (Xinqiao Hospital Army Medical University; Department of Neurology); Geng Xiaokun (Beijing Luhe Hospital,Capital Medical University; Department of Neurology); Zhang Shiyong (Beijing Fengtai You’anmen Hospital; Department of Neurology); Zhou Zhiming (Yijishan Hospital of Wannan Medical College; Department of Neurology); Chen Wenhuo (Zhangzhou Municipal Hospital of Fujian Province; Department of Neurology); Wang Yizhou (Guangdong Hospital of TCM; Department of Neurosurgery); Liao Geng (Maoming People's Hospital; Department of Neurology); Liu Yajie (Southern Medical University Shenzhen Hospital; Department of Neurosurgery); Ling Wentong (Zhongshan People's Hospital; Department of Neurology); LI Tong (The Second Nanning People's Hospital; Department of Neurology); Xu Guodong (Hebei General Hospital; Department of Interventional Neuroradiology); Gui Liqiang (Langfang Changzheng Hospital; Emergency and Critical Stroke Ambulance Center); Li Tianxiao (Henan Province Hospital; Department of Neurology); Zhang Jiangang (The People's Hospital Of Anyang City; Department of Neurology); Ju Dongsheng (Songyuan Jilin Oilfield Hospital; Department of Neurology); Zhao Junfeng (Siping Central People's Hospital; Department of Neurology); Shi Haibin (Jiangsu Province Hospital; Department of Interventional radiology; Pen Ya (The First People's Hospital of Changzhou; Department of Neurosurgery); Liu Yan (Jingjiang People's Hospital; Department of Neurology); Shi Hongchao (Nanjing First Hospital; Department of Neurology); Wu Jin (The Second Affiliated Hospital of Nanjing Medical University; Department of Neurology); Ding Yasuo (Jiangsu Taizhou People's Hospital; Department of Neurosurgery); Song Weigen (Yancheng Third People's Hospital; Department of Neurology); Li Di (Dalian Municipal Central Hospital Affiliated to Dalian Medical University; Department of Interventional therapy); Jiang Changchun (Baotou Central Hospital; Department of Neurology); Zhu Qiyi (Linyi People's Hospital; Department of Neurology); Han Hongxing (Linyi People's Hospital; Department of Neurology); Wang Guoqing (Binzhou People's Hospital; Department of Neurology); Song Cunfeng (Liaocheng Third People's Hospital; Department of Neurology); LI Weirong (Taiyuan Central Hospital of Shanxi Medical University; Department of Neurology); Zhao Jing (Minhang Hospital Affiliated to Fudan University; Department of Neurology); Bi Yong (Shanghai Fourth People's Hospital; Department of Neurology); Zheng Hongbo (West China Hospital, Sichuan University; Department of Neurology); Luo Jun (Sichuan Mianyang 404 Hospital; Department of Neurology); Li Jinglun (The Affiliated Hospital Of Southwest Medical University; Department of Neurology); Wei Ming (Tianjin Huanhu Hospital; Department of Neurosurgery); Guo Zaiyu (Teda Hospital; Department of Neurosurgery); Yin Congguo (Affliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology); Wang En (Taizhou Hospital of Zhejiang Province; Department of Neurology); Liu Shudong (Yongchuan Hospital of Chongqing Medical University; Department of Neurology); Cai Chuwei (Shantou Central Hospital; Department of Neurosurgery); Zhang Meng (Daping Hospital; Department of Neurology); Cai Xueli (Lishui City Center Hospital; Department of Neurology); Nan Guangxian (China-Japan Union Hospital Of Jilin University; Department of Neurology); Zhang Liyong (Liao city brain hospital in Shandong Province; Department of Neurosurgery); Yang Hua (The Affiliated Hospital Of Guizhou Medical University; Department of Neurosurgery); Sun Yaxuan (Shanxi Province Hospital; Department of Neurology); Xu Na (The Second Affiliated Hospital of Xiamen Medical College; Department of Neurology); Yang Xinguang (The Second Affiliated Hospital Of Guangzhou Medical University; Department of Neurology); Yuan Guangxiong (Xiangtan Central Hospital; Department of Critical Care Medicine); Dai Linzhi (First Affiliated Hospital, School of Medicine, Shihezi University; Department of Neurosurgery); Huang Wenguo (Maoming Hospital of Traditional Chinese Medicine; Department of Neurology); Gao Zongen (Shengli Oilfield Central Hospital; Department of Neurology); Shi Qing (Wuyi Hospital of traditional Chinese medicine, Jiangmen city; Department of Encephalopathy); Tang Yufeng (Mianyang Central Hospital; Department of Neurology); Yue Wencan (Zhoukou Central Hospital; The centre of stroke); Wen Changming (Nanyang Central Hospital; Department of Neurology). ANGEL-ASPECT Steering Committee: Miao Zhongrong (Beijing Tiantan Hospital, Capital Medical University; Tiantan Interventional Neuroradiology); Ren Zeguang (University of south Florida, Tampa General Hospital, United States of America; Tiantan Interventional Neuroradiology); Vitor Mendes Pereira (St. Michael's Hospital, Toronto, Canada; Division of Neurosurgery, Department of Surgery); Wang Yongjun (Beijing Tiantan Hospital, Capital Medical University; Department of Neurology); Wang Yilong (Beijing Tiantan Hospital, Capital Medical University; Department of Neurology); Liu Liping (Beijing Tiantan Hospital, Capital Medical University; Department of Neurology); David Liebeskind (UCLA Comprehensive Stroke Center; Department of Neurology).

      • Contributors Conceptualization: XJH, DPS, XCH, ZMZ. Study design: XJH, ZMZ. Methodology: XJH, OOZ. Data collection: all authors. Investigation: XJH, DPS. Statistical analysis: YSP, MXW. Writing—original draft: XJH, TNN, MA. Writing—review and editing: all authors. Approval of final manuscript: all authors. Guarantors: ZMZ and XCH.

      • Funding This work was supported by the Natural Science Research Projects in Anhui Universities (No. KJ2021A0843), the Scientific Research Fund Project for Talent Introduction of Yijishan Hospital, Wannan Medical College in China (No.YR 202210), Anhui Provincial Health Backbone Talent Training Target Project and Anhui Province University Excellent Top Talent Cultivation Project.

      • Competing interests None declared.

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

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