Incidence and potential predictors of first pass effect within 30 min of groin puncture: An exploratory single-center study

Abstract

Background and Purpose

The first pass effect (FPE), achieving near-complete revascularization in a single pass, predicts good outcomes in mechanical thrombectomy (MT). FPE30, achieving FPE within 30 min of groin puncture, is a novel procedural metric proposed as an indicator of maximal procedural and systems-level efficiency. This study aimed to determine the incidence of FPE30 and explore potential predictors in a real-world clinical setting, thereby assessing its utility as a performance benchmark.

Methods

We retrospectively analyzed 274 consecutive MT patients at a comprehensive stroke center. The primary outcome was FPE30, defined as achieving mTICI 2c-3 in a single pass within 30 min of groin puncture. Patient characteristics were compared between FPE30 and FPE > 30 groups.

Results

Of 274 patients, 52 (19.0%) achieved FPE; 43 (82.7%) met the FPE30 benchmark. No statistically significant predictors of FPE30 were found. Trends indicated FPE30 was less common in internal carotid artery (ICA) terminus occlusions (7.0% vs. 33.3%; P = .09) and more frequent with radial access (48.8% vs. 33.3%; P = .40). There was no significant difference in good 90-day functional outcomes (mRS 0-2) between FPE30 (34.9%) and FPE > 30 (33.3%) groups (P > .99).

Conclusions

Achieving FPE within 30 min was common in this cohort, but not significantly predicted by measured factors. The lack of an association between FPE30 and improved 90-day functional outcomes suggests that the primary benefit is derived from achieving FPE itself, regardless of whether it is accomplished within or just beyond this ultra-early timeframe. Trends suggest occlusion location and access site may affect reperfusion speed. Lack of functional benefit difference highlights that FPE achievement itself remains the key outcome determinant. These findings are hypothesis-generating and warrant larger studies to clarify the value and predictors of FPE30 as both a clinical prognosticator and a quality improvement metric.