| Background: The successful standard of mechanical thrombectomy in acute ischemic stroke patients with large-vessel occlusion is that TICI grade reaches good perfusion grade(mTICI2 B or mTICI3)immediately after mechanical thrombectomy.With the progress of mechanical thrombectomy technology and instruments,more and more patients have the opportunity to achieve complete reperfusion(m TICI3).However,some studies have shown that numbers of stent retriever passes are often increased in order to achieve m TICI3.At present,some foreign studies have shown that frst pass effect(FPE),which means complete reperfusion(m TICI3)at the first pass of thrombectomy,should be the standard to represent technical success.But most studies only focus on the long-term prognosis is good or not(m RS score≤ 2).Researches on other prognostic outcomes of patients are not clear,and there are still few related studies in China,Especially for some patients whose thrombectomy reaches m TICI2 B for the first pass,whether the prognosis is better after increasing the number of stent retriever passes to m TICI3 is still few unknown both at home and abroad.Objective: To investigate the correlation study of number of stent retriever passes and good reperfusion grade on the prognosis of stroke patients with acute large vessel occlusion treated with mechanical thrombectomy.Methods: The study retrospectively and continuously included 168 patients who were diagnosed as acute large artery occlusive ischemic stroke in the Stroke Center of the Second Hospital of Dalian Medical University from April 2016 to August 2022 and were treated with mechanical thrombectomy to achieve good perfusion grade(m TICI2 B and m TICI3).First,the patients were divided into first pass effect group and non-first pass effect group according to whether they achieved complete reperfusion(m TICI3)after the first pass,and the baseline data and outcomes between the two groups were analyzed and compared.Then we compare the clinical outcomes of patients who achieved m TICI2 B for the first pass with those who achieved m TICI3 for the 2-pass and ≥ 3-pass.The main outcomes were as follows: according to the score of the 90-day modified Rankin scale(mRS),the prognosis was good(m RS≤2),or the prognosis was better(m RS ≤ 3).Secondary outcome measures were intracranial hemorrhage during hospitalization,symptomatic intracranial hemorrhage,and all-cause death within 90 days.According to univariate analysis and multivariate logistic regression analysis,the relationship with clnical outcomes was determined.Results: 1.Comparison between first pass effect group and non-first pass effect group.A total of 168 patients with successful recanalization after mechanical thrombectomy were included in the analysis.According to whether the patients had first-pass effect or not,they were divided into first pass effect group(N=67 cases)and non-first pass effect group(N=101 cases).(1)The results of univariate analysis showed that the preoperation ASPECTS score of the first-pass effect group was higher than that of the non-first-pass effect group [10(8-10)vs 9(8-10),P=0.021],and the operation time was shorter [60(45,90)vs 120(85,150),P=0.001];the proportion of good prognosis(m RS≤2 points)was higher(53.7%vs33.7%,P=0.010),and the proportion of better prognosis(m RS≤3 points)was higher(64.2% vs40.6%,P=0.003),the difference between the two groups was statistically significant(P≤0.05,P≤0.01).There was no significant difference between the two groups in intracranial hemorrhage during hospitalization,symptomatic intracranial hemorrhage,and all-cause death within 90 days.The results of multivariate Logistic regression analysis with adjusted confounding factors showed that there was a positive correlation between the first-pass effect group and 90-day better prognosis(m RS score≤3)(a OR=2.298,95%CI:1.114-4.739,P=0.024).2.Comparison between First pass m TICI2 B group,2 pass m TICI3 group and ≥ 3 pass m TICI3 group.A total of 72 patients were included in the analysis.According to the number of retriver passes and m TICI grade,the patients were divided into three groups: first pass m TICI2 B group(n = 22),2-pass m TICI3 group(n=36)and ≥3-pass m TICI3 group(n=14).(1)The results of univariate analysis showed that there was significant difference in the incidence of atrial fibrillation history among the first pass m TICI2 B group,the 2-pass m TICI3 group and the ≥3-Pass m TICI3 group(36.4% vs 66.1% vs 78.6%,P=0.035).There was significant difference in the incidence of symptomatic intracranial hemorrhage among the three groups(4.5% vs 8.3% vs 35.7%,P=0.022).There was no statistical difference in the proportion of good prognosis(m RS≤2),better prognosis(m RS≤3),intracranial hemorrhage during hospitalization and death within 90 d.(P >0.05).Further multiple comparison showed that there was no significant difference in clinical prognosis between the first-pass m TICI2 B group and the 2-pass m TICI3 group(P > 0.025).In the comparison of prognostic outcome between the first pass m TICI2 B group and the ≥3-pass m TICI3 group,it was found that the first pass m TICI2 B group had a lower incidence of symptomatic intracranial hemorrhage(4.5% vs 35.7%,P=0.024),and the difference was statistically significant,but there was no significant difference in the incidences of good prognosis,better prognosis,intracranial hemorrhage during hospitalization and long-term death(P > 0.025).(2)Multivariate logistic regression analysis adjusted for confounding factors showed that there was a significant correlation between the ≥3 pass m TICI3 group and the first pass m TICI2 B group in the occurrence of symptomatic intracranial hemorrhage,which was statistically significant.(OR=30.511,95%CI:1.350-689.674,P=0.032)Conclusions: 1.The first pass effect of mechanical embolectomy is significantly better than that of non-first-pass effect patients in terms of the incidence of better prognosis(m RS≤3).2.The first-pass effect of mechanical embolectomy has no effect on the intracranial hemorrhage during hospitalization,symptomatic intracranial hemorrhage,good prognosis within 90 days(m RS≤ 2)and death within 90 days.3.There was no statistical difference between the patients who achieved first pass m TICI2 B and the patients who achieved 2-pass m TICI3 in terms of good prognosis(m RS≤2),better prognosis(m RS≤3),intracranial hemorrhage during hospitalization,symptomatic intracranial hemorrhage and death within 90 days.4.The incidence of symptomatic intracranial hemorrhage was lower in the patients who reached first pass mTICI2 B compared with patients who reached ≥3-pass mTICI3. |
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