We investigated the effect of First Pass Thrombectomy (FPT) and recanalization in our acute stroke population.

The potential benefit of FPT and rapid recanalization has been demonstrated in a few recent studies, but the available evidence is limited.

We performed a retrospective review of mechanical thrombectomy cases for acute ischemic stroke with large vessel occlusion from 2017-2019 in our institution. Cases specifically performed primarily with aspiration thrombectomy (+/- adjunct stentriever therapy) were selected. Rates of successful TICI 2B/3 recanalization, time from groin puncture to recanalization, and NIHSS change from admission to discharge (delta NIHSS) were analyzed. We compared the differences between FPT and multiple recanalization attempts.

From over 220 cases with primary aspiration catheter utilization, the majority was performed with Sofia suction catheters (n=177, 77.6%), about half (48%) without a stentriever. Mean patient age was 66.8 ± 15 years, and 53.1% patients were female. Median (IQR) premorbid mRS was 1 (0-1). TPA was administered to 41.2% of patients. The fastest procedure was achieved with aspiration alone at a median (IQR) time of 32.5 (24-48.8) min. FPT compared with multiple pass recanalization resulted in significantly shorter median (IQR) recanalization times (34.5 (26-54.5) vs 65 (46-89) min, p<0.001), higher TICI 2B/3 rates (94.3% vs 64.7%, p<0.001), and improved clinical outcomes, as evidenced by higher median (IQR) delta NIHSS (12 (5.5-17) vs 6.5 (1-11.8), p=0.002).

FPT and faster recanalization appear to result in better clinical outcomes, and should be the primary goal of mechanical thrombectomy in acute stroke. The development of more efficient and safe first line devices and techniques will have a significant impact on overall procedural and clinical success.