European Journal of Medical Research (Aug 2025)

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

  • Ning Han,
  • Yangjuan Jia,
  • Guodong Xu,
  • Yan Zhao,
  • Hebo Wang

DOI
https://doi.org/10.1186/s40001-025-03022-3
Journal volume & issue
Vol. 30, no. 1
pp. 1 – 8

Abstract

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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.

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