Impact of Reperfusion Quality and Pass Number on Functional Outcomes in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy.

Abstract

To compare functional outcomes between patients achieving good reperfusion (eTICI 2B) after a single pass and those requiring multiple passes to achieve excellent or complete reperfusion (eTICI 2C/3) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). This single-center retrospective cohort study included 301 AIS patients with large vessel occlusion who underwent MT between January 2018 and December 2022. Patients were categorized into single-pass eTICI 2B (n = 65) and multiple-pass eTICI 2C/3 (2-5 passes, n = 214; >5 passes, n = 22). Functional outcomes were assessed at 90 days using the modified Rankin Scale. Early neurological deterioration, adverse events, and safety outcomes were also analyzed. No significant difference was observed in a 90-day functional independence between single-pass eTICI 2B and multiple-pass eTICI 2C/3 (47.7% vs. 41.5%, P = 0.39 for 2-5 passes; 27.3% vs. 41.5%, P = 0.24 for >5 passes). However, patients requiring more than 5 passes to achieve eTICI 2C/3 had significantly higher rates of early neurological deterioration (40.9% vs. 18.5%, P = 0.04) and adverse events (63.6% vs. 38.5%, P = 0.04). Mortality rates were similar between groups. Our study suggests that achieving eTICI 2C/3 through multiple passes does not result in improved functional outcomes compared to single-pass eTICI 2B. Moreover, extended thrombectomy procedures may increase the risk of early neurological deterioration and adverse events, highlighting the need for careful procedural strategy in MT for AIS patients.