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. 2022 May 2:13:884235.
doi: 10.3389/fneur.2022.884235. eCollection 2022.

First Pass Effect and Location of Occlusion in Recanalized MCA M1 Occlusions

Hisham Salahuddin  1   2   3 , Rahul R Rao  1   2 , Syed F Zaidi  1   2 , Paige Prologo-Richardson  2 , Fatima Khalid  2 , Linda Saju  2 , Muhammad Asif Taqi  4 , Richard R Burgess  1   2 , Mouhammad A Jumaa  1   2
Affiliations

First Pass Effect and Location of Occlusion in Recanalized MCA M1 Occlusions

Hisham Salahuddin et al. Front Neurol. .

Abstract

Background: The first pass effect has been shown to improve clinical outcomes in patients with middle cerebral artery (MCA) M1 occlusions.

Objective: To determine the rates of first pass effect in MCA M1 occlusions and determine if proximal or distal location of occlusion modified clinical outcomes.

Methods: Patients with recanalized MCA M1 occlusions who underwent endovascular thrombectomy (EVT) were reviewed to determine the effect of first pass effect (FPE) and location of occlusion on clinical outcomes. MCA occlusions were classified as proximal if they included the first two thirds of the MCA and involved the lenticulostriate vessels, or distal if they did not.

Results: We included 261 patients of which 27% achieved FPE. Of the cohort, there were 91 (35%) proximal MCA occlusions and 170 (65%) distal MCA occlusions. Baseline demographics and treatment time metrics were comparable across both groups. There was a trend toward good clinical outcome in patients with or without a FPE (60 vs. 46%; p = 0.06), however a higher rate of excellent clinical outcome was noted in patients with FPE (46 vs. 30%; p = 0.02). When compared by location, patients with distal MCA occlusions had a higher rate of excellent clinical outcome (40 vs. 25%; p = 0.02). Multivariable analysis showed that distal MCA occlusion was the strongest predictor of an excellent clinical outcome and first pass effect.

Conclusion: Patients with MCA M1 occlusions with FPE have a higher rate of excellent clinical outcomes compared to those who did not. Location of MCA occlusion appears to modify rates of first pass effect and excellent clinical outcomes.

Keywords: acute ischemic stroke; first pass effect (FPE); large vessel occlusion (LVO); location; thrombectomy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patients included in the study; cohort by first pass effect in red (left) and cohort by proximal or distal MCA occlusions in green (right). Ten patients were loss to follow up.
Figure 2
Figure 2
(A) Modified Rankin Scale of patients with first pass effect and no first pass effect at 3 months. (B) Modified Rankin Scale of patients with proximal or distal middle cerebral artery occlusions at 3 months.
See this image and copyright information in PMC

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