• Muhammad Ubaid Hafeez, Peter Kan, Aditya Srivatsan, Shawn Moore, Mostafa Jafari, Carlos DeLaGarza, Komal Hafeez, Fabio A Nascimento, Visish M Srinivasan, Jan-Karl Burkhardt, Stephen Chen, Jeremiah Johnson, and Yasir Saleem.
• Department of Neurology, Baylor College of Medicine, Houston, Texas, USA. Electronic address: muhammad.hafeez@bcm.edu.
• World Neurosurg. 2020 Dec 1; 144: e533-e540.

BackgroundFirst-pass efficacy (FPE) is an established marker of technical and clinical efficacy among mechanical thrombectomy (MT) techniques. It is unclear what the optimal approach is in achieving FPE. We present a single-center experience comparing rates of FPE among 2 MT techniques and evaluate the potential predictors of FPE among other outcomes.MethodsA single-center retrospective analysis was carried out of patients with consecutive large-vessel occlusion strokes (LVOS) of anterior circulation from September 2015 to April 2019 who underwent MT and for whom data were available on the status of FPE. Four MT techniques were identified: ADAPT (a direct first-pass aspiration), SrADAPT (stent retriever with aspiration), SRBG (stent retriever with balloon guide catheter), and STRAP (stent retriever-aspiration and proximal flow arrest). The primary outcome was FPE and secondary outcomes included the rate of successful reperfusion.ResultsAmong 226 patients with LVOS of the anterior circulation who underwent MT, data were available for 164 on FPE for the 4 MT techniques. SRBG was the most prevalent technique. No significant difference was found in rates of FPE among the 4 MT techniques (P = 0.332). No independent predictors of FPE were identified on multivariable analysis. STRAP had the highest rate of successful reperfusion compared with the other techniques (P = 0.049) and was the only independent predictor of that outcome (P = 0.027).ConclusionsAmong patients with LVOS of the anterior circulation, the rate of FPE did not differ among the 4 MT techniques. There were no predictors of FPE among the studied variables. STRAP was the only predictor of successful reperfusion.Copyright © 2020 Elsevier Inc. All rights reserved.

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