O-001 Predictors of the first pass effect with neurothrombectomy for acute ischemic stroke

Introduction Achieving complete revascularization after a single attempt with mechanical thrombectomy (First pass effect, FPE) in the setting of an acute ischemic stroke due to large vessel occlusion (LVO) is associated with significantly higher rates of a good clinical outcome. We aim to identify predictors of FPE in a large real word registry of patients undergoing thrombectomy. Methods Data were analyzed from the STRATIS registry -- a prospective, nonrandomized study of patients undergoing neurothrombectomy with the Solitaire device. A total of 984 patients treated at 55 sites were analyzed. Univariate and multivariable logistic regression was used to assess the relationship between patient characteristics (demographics, clinical, occlusion location, collateral grade) and procedural features with FPE. Complete data was only available for 930 patients. Results First pass effect was achieved in 40% (ns=372) of patients. Patients in the FPE group were older (69 ±15 vs 67 ±15 years, p=0.02) and had less internal carotid artery (ICA) occlusions (17% vs 28%, p=0.001). While rates of symptomatic intracranial hemorrhage (0.6% vs 2.2%, p=0.13) were comparable, rates of mRS 0–2 at 90 days were higher (66% vs 49%, p≤0.001) and mortality at 90 days (12% vs 19%, p=0.008) were lower in the FPE group compared to the non-FPE group. Multivariable regression analysis identified absence of ICA occlusion (p=0.01), the use of a balloon guided-catheter (p=0.001) and better collateral grade (p≤0.001), as independent predictors of FPE. Conclusion Non-ICA site of occlusion, the use of a balloon-guided catheter and better collateral grade are independent predictors of FPE. Further understanding of these factors may influence choice of thrombectomy device and technique. Disclosures A. Jadhav: None. O. Zaidat: None. S. Desai: None. R. Nogueira: None. N. Mueller-Kronast: None. T. Jovin: None. D. Liebeskind: None.