RT Journal Article SR Electronic T1 Beyond the first pass: revascularization remains critical in stroke thrombectomy JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP 1095 OP 1099 DO 10.1136/neurintsurg-2019-014773 VO 11 IS 11 A1 Jindal, Gaurav A1 Carvalho, Helio De Paula A1 Wessell, Aaron A1 Le, Elizabeth A1 Naragum, Varun A1 Miller, Timothy Ryan A1 Wozniak, Marcella A1 Shivashankar, Ravi A1 Cronin, Carolyn A A1 Schrier, Chad A1 Gandhi, Dheeraj YR 2019 UL http://jnis.bmj.com/content/11/11/1095.abstract AB 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.