Background and Purpose:In the settings of thrombectomy, the first-pass effect (FPE), defined by a complete recanalization after one pass with no rescue therapy, has been shown to be associated with an improved outcome. As this phenomenon has been predominantly described in anterior circulation strokes, we aimed to study the prevalence, outcomes, and predictors of FPE in patients with a basilar artery occlusion.Methods:From a prospective multicentric registry, we collected the data of all consecutive basilar artery occlusion patients who underwent thrombectomy and compared the outcomes of patients who achieved FPE and those who did not. We also compared FPE patients with those who achieved a complete recanalization with >1 pass. Finally, a multivariate analysis was performed to determine the predictors of FPE.Results:Data from 280 patients were analyzed in our study, including 84 of 280 patients (30%) with an atheromatous etiology. An FPE was achieved in 93 patients (33.2%), with a significantly higher proportion of good outcomes (modified Rankin Scale score 0-2 at 3 months) and lower mortality than non-FPE patients. An FPE was also associated with improved outcomes compared with patients who went on to have full recanalization with >1 pass. Contact aspiration as first-line strategy was a strong predictor of FPE, whereas baseline antiplatelets and atheromatous etiology were negative predictors.Conclusions:In our study, an FPE was achieved in approximately one-third of patients with a basilar artery occlusion and was associated with improved outcomes. More research is needed to improve devices and techniques to increase the incidence of FPE.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03776877.

中文翻译：

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基底动脉闭塞的首过效应：缺血性卒中登记处血管内治疗的见解

背景和目的：在血栓切除术的情况下，首过效应（FPE），定义为在没有抢救治疗的情况下一次通过后完全再通，已被证明与改善结果相关。由于这种现象主要在前循环卒中中描述，我们旨在研究基底动脉闭塞患者 FPE 的患病率、结果和预测因素。方法：从前瞻性多中心登记处，我们收集了所有连续基底动脉的数据闭塞患者接受了血栓切除术，并比较了获得 FPE 的患者和未获得 FPE 的患者的结果。我们还比较了 FPE 患者与完全再通 > 1 次的患者。最后，进行多变量分析以确定 FPE 的预测因子。结果：在我们的研究中分析了来自 280 名患者的数据，包括 280 名患者中的 84 名（30%）患有动脉粥样硬化病因。93 名患者（33.2%）实现了 FPE，与非 FPE 患者相比，良好结局的比例显着更高（改良 Rankin 量表评分 3 个月时 0-2 分）和更低的死亡率。与继续通过 >1 次完全再通的患者相比，FPE 也与改善的结果相关。作为一线策略的接触抽吸是 FPE 的强预测因子，而基线抗血小板和动脉粥样硬化病因是负预测因子。结论：在我们的研究中，大约三分之一的基底动脉闭塞患者实现了 FPE，并且与改善的结果。需要更多的研究来改进设备和技术以增加 FPE 的发生率。注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT03776877。