Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study.
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Dmytriw Adam A, Kiani Iman, Bhatia Kartik, Abruzzo Todd, Pabst Lisa, Fraser Stuart, Chung Melissa G, Lo Warren, Othmann Ahmed, Steinmetz Sebastian, Jensen-Kondering Ulf, Schob Stefan, Kaiser Daniel P O, Marik Wolfgang, Wendl Christina, Kleffner Ilka, Henkes Hans, Kraehling Hermann, Nguyen-Kim Thi Dan Linh, Chapot René, Yilmaz Umut, Wang Furene, Ubaid Hafeez Muhammad, Requejo Flavio, Limbucci Nicola, Kauffmann Birgit, Möhlenbruch Markus, Nikoubashman Omid, Schellinger Peter D, Dugar Franja, Musolino Patricia, Alawieh Ali, Wilson Jenny, Grieb Dominik, Gersing Alexandra S, Liebig Thomas, Olivieri Martin, Paulasova Schwabova Jaroslava, Tomek Ales, Papanagiotou Panagiotis, Boulouis Grégoire, Naggara Olivier, Fox Christine K, Orlov Kirill, Kuznetsova Alexandra, Parra-Farinas Carmen, Muthusami Prakash, Regenhardt Robert W, Martinez Mesha L, Brechbühl Daniel, Steinlin Maja, Sun Lisa R, Hassan Ameer E, Guenego Adrien, Molyneux Andrew, Kemmling André, Lee Sarah, Fullerton Heather J, Fiehler Jens, Psychogios Marios-Nikos, Wildgruber Moritz, Sporns Peter B, Save Child S Pro Investigators
Аннотация
PATIENTS AND METHODS: We analysed prospectively collected data from the international Save ChildS Pro registry (ages 0-17 years). All EVT-treated patients were included irrespective of the reperfusion grade achieved. Successful reperfusion was defined as expanded thrombolysis in cerebral infarction (eTICI) ≥ 2b and complete/near-complete reperfusion as eTICI 2c-3. The primary outcome was ordinal 90-day mRS in a proportional odds model. Single-pass and multiple-pass patients were then compared with each other within the subgroup achieving eTICI 2c-3. Logistic regression for mRS > 2 was fitted with pass count and eTICI grade as covariates.
RESULTS: Of 103 patients (median age 11 years [IQR 6-15]; 55/102 [53.9%] male), median passes were 2 (IQR 1-3); 39 (37.9%) had 1 pass, 61 (59.2%) more than 1 and 3 (2.9%) recanalised without a thrombectomy pass. Multiple passes were associated with lower eTICI 2c-3 rates (30.0% vs 82.1%; P < .001), and worse 90-day mRS (common odds ratio 3.47; 95% CI, 1.63-7.38; P = .001). However, among patients achieving eTICI 2c-3 (n = 50), we detected no difference by pass count (mRS 0-2: 93.8% vs 94.4%; risk difference - 0.6%, 95% CI, -15% to +20%; P = 1.000). After accounting for eTICI, pass count was not independently associated with mRS > 2, while eTICI remained significant.
CONCLUSIONS: In this analysis of the first-pass effect in paediatric thrombectomy, multiple passes were associated with worse functional outcomes, but this effect appeared to be largely mediated through recanalisation quality. Subgroup analyses were underpowered to exclude a clinically relevant residual effect of pass count, and these findings should be considered hypothesis-generating.