Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes.
J Neurointerv Surg
; 13(3): 212-216, 2021 Mar.
Article
em En
| MEDLINE
| ID: mdl-33441394
ABSTRACT
BACKGROUND:
First pass effect (FPE) in mechanical thrombectomy is thought to be associated with good clinical outcomes.OBJECTIVE:
To determine FPE rates as a function of thrombectomy technique and to compare clinical outcomes between patients with and without FPE.METHODS:
In July 2020, a literature search on FPE (defined as modified Thrombolysis in Cerebral Infarction (TICI) 2c-3 after a single pass) and modified FPE (mFPE, defined as TICI 2b-3 after a single pass) and mechanical thrombectomy for stroke was performed. Using a random-effects meta-analysis, we evaluated the following outcomes for both FPE and mFPE overall rates, rates by thrombectomy technique, rates of good neurologic outcome (modified Rankin Scale score ≤2 at day 90), mortality, and symptomatic intracerebral hemorrhage (sICH) rate.RESULTS:
Sixty-seven studies comprising 16 870 patients were included. Overall rates of FPE and mFPE were 28% and 45%, respectively. Thrombectomy techniques shared similar FPE (p=0.17) and mFPE (p=0.20) rates. Higher odds of good neurologic outcome were found when we compared FPE with non-FPE (56% vs 41%, OR=1.78) and mFPE with non-mFPE (57% vs 44%, OR=1.73). FPE had a lower mortality rate (17% vs 25%, OR=0.62) than non-FPE. FPE and mFPE were not associated with lower sICH rate compared with non-FPE and non-mFPE (4% vs 18%, OR=0.41 for FPE; 5% vs 7%, OR=0.98 for mFPE).CONCLUSIONS:
Our findings suggest that approximately one-third of patients achieve FPE and around half of patients achieve mFPE, with equivalent results throughout thrombectomy techniques. FPE and mFPE are associated with better clinical outcomes.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Isquemia Encefálica
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Trombectomia
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Acidente Vascular Cerebral
Tipo de estudo:
Risk_factors_studies
/
Systematic_reviews
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Neurointerv Surg
Ano de publicação:
2021
Tipo de documento:
Article