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. 2025 Aug 11;30(1):729.
doi: 10.1186/s40001-025-03022-3.

The effect of first pass effect in mechanical thrombectomy for acute terminal internal carotid artery occlusion

Ning Han  1   2   3 , Yangjuan Jia  4 , Guodong Xu  2   3 , Yan Zhao  2   3 , Hebo Wang  5   6   7
Affiliations

The effect of first pass effect in mechanical thrombectomy for acute terminal internal carotid artery occlusion

Ning Han et al. Eur J Med Res. .

Abstract

Introduction: This study aimed to elucidate the impact of the first-pass effect (PFE) on patients with acute terminal internal carotid artery occlusion.

Methods: We conducted a retrospective analysis of patients with acute terminal internal carotid artery occlusion who underwent endovascular treatment. PFE was defined as achieving complete revascularization with a single use of the thrombectomy device, without the requirement for salvage therapy during the procedure. The primary functional outcome was measured using the 90-day modified Rankin Scale (mRS). mRS score of 0-3 was defined as a favorable outcome. A comprehensive assessment was performed on baseline patient characteristics, procedural parameters, and clinical outcomes. Multivariate analysis was employed to determine the association between PFE and 90-day functional outcomes.

Results: A total of 150 patients were included, of which 36 (24%) achieved PFE. Compared to the non-PFE group, the PFE group exhibited lower rates of general anesthesia, higher rates of intravenous thrombolysis and aspiration thrombectomy, and a shorter puncture-to-recanalization time. When contrasted with the unfavorable outcome group, the favorable outcome group presented with lower NIHSS scores, shorter puncture-to-recanalization durations, a reduced prevalence of atrial fibrillation, and a higher proportion of PFE. Multivariate analysis revealed that PFE was significantly associated with favorable functional outcomes (mRS 0-3, 49.12% vs. 72.22%; adjusted odds ratio [aOR], 3.78; 95% confidence interval [CI], 1.21-11.81; P = 0.022), yet showed no significant association with secondary or safety outcomes.

Conclusion: This study demonstrates that among patients with acute terminal internal carotid artery occlusion who underwent endovascular treatment, 24% achieved FPE, which was associated with improved 90-days functional outcome.

Keywords: First-pass effect; Function outcomes; Mechanical thrombectomy; Stroke; Terminal internal carotid artery occlusion.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the population included in the study
Fig. 2
Fig. 2
The distribution of 90-days functional outcome in all patients, as well as in the FPE and Non-FPE groups
Fig. 3
Fig. 3
Proportion of causes of death in deceased patients
Fig. 4
Fig. 4
Subgroup analyses. The forest plot shows the impact of FPE achieved in subgroups of different variables on functional outcome. The OR was calculated by using a multivariable logistic regression, taking the following variables into the adjustment: age, sex, atrial fibrillation, PTR, NIHSS, ASPECTS and aspiration thrombectomy
See this image and copyright information in PMC

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