@article {Ducroux386, author = {C{\'e}lina Ducroux and Michel Piotin and Benjamin Gory and Julien Labreuche and Raphael Blanc and Malek Ben Maacha and Bertrand Lapergue and Robert Fahed}, editor = {, and , and Redjem, Hocine and Ciccio, Gabriele and Smajda, Stanislas and Mazighi, Mikael and Desilles, Jean-Philippe and Escalard, Simon and Rodesch, Georges and Consoli, Arturo and Coskun, Oguzhan and Maria, Federico Di and Bourdain, Fr{\'e}d{\'e}ric and Decroix, Jean Pierre and Wang, Adrien and Tchikviladze, Maya and Evrard, Serge and Turjman, Francis and Gory, Benjamin and Labeyrie, Paul Emile and Riva, Roberto and Mounayer, Charbel and Saleme, Suzanna and Costalat, Vincent and Bonafe, Alain and Eker, Omer and Gascou, Gr{\'e}gory and Dargazanli, Cyril and Bracard, Serge and Tonnelet, Romain and Derelle, Anne Laure and Anxionnat, Ren{\'e} and Desal, Hubert and Bourcier, Romain and Daumas-Duport, Benjamin and Berge, J{\'e}rome and Barreau, Xavier and Marnat, Gauthier and Djemmane, Lynda and Labreuche, Julien and Duhamel, Alain}, title = {First pass effect with contact aspiration and stent retrievers in the Aspiration versus Stent Retriever (ASTER) trial}, volume = {12}, number = {4}, pages = {386--391}, year = {2020}, doi = {10.1136/neurintsurg-2019-015215}, publisher = {British Medical Journal Publishing Group}, abstract = {Background The {\textquoteleft}first pass effect{\textquoteright} (FPE), which was originally described with stent retrievers, designates a (near-)complete revascularization obtained after a single device pass with no rescue therapy, and is associated with improved clinical outcome and decreased mortality.Objective We report the rate and benefits of FPE in the Aspiration versus Stent Retriever (ASTER) trial.Materials and methods ASTER is a randomized trial comparing angiographic revascularization with the stent retriever (SR) and contact aspiration (CA) thrombectomy techniques, assessed by an external core laboratory using the modified Thrombolysis in Cerebral Infarction (mTICI) scale. Rates of FPE (defined by mTICI 2c/3 after a single pass with no rescue therapy) were compared between patients treated with SR and CA techniques. Outcomes were compared between FPE-SR and FPE-CA patients, and between FPE and non-FPE patients.Results FPE was achieved in 97/336 patients (28.9\%), with no significant difference between SR and CA (respectively 53/169 patients (31.3\%) vs 44/167 patients (26.3\%), adjusted RR for CA versus SR 0.84, 95\% CI 0.54 to 1.31; p=0.44). After prespecified adjustment for allocated arm and randomization stratification factors, FPE in patients was associated with a significantly improved clinical outcome and a decreased mortality, and a significantly lower rate of hemorrhagic transformation and procedural complications than in non-FPE patients.Conclusion In the ASTER trial, similar rates of FPE were achieved with SR and CA, and FPE was associated with a significantly improved outcome. New techniques and devices to improve the rate of FPE are warranted.Trial registration number Unique identifier: NCT02523261.}, issn = {1759-8478}, URL = {https://jnis.bmj.com/content/12/4/386}, eprint = {https://jnis.bmj.com/content/12/4/386.full.pdf}, journal = {Journal of NeuroInterventional Surgery} }