Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: In adult endovascular thrombectomy (EVT), first-pass success is associated with better outcomes, but whether this "first-pass effect" also holds true in childhood stroke remains unknown. We investigated the association of thrombectomy pass counts with 90-day outcomes after paediatric EVT. PATIENTS AND METHODS: We analysed prospectively collected data from the international Save ChildS Pro registry (ages 0-17 years). All EVT-treated patients were included irrespective of the reperfusion grade achieved. Successful reperfusion was defined as expanded thrombolysis in cerebral infarction (eTICI) ≥ 2b and complete/near-complete reperfusion as eTICI 2c-3. The primary outcome was ordinal 90-day mRS in a proportional odds model. Single-pass and multiple-pass patients were then compared with each other within the subgroup achieving eTICI 2c-3. Logistic regression for mRS > 2 was fitted with pass count and eTICI grade as covariates. RESULTS: Of 103 patients (median age 11 years [IQR 6-15]; 55/102 [53.9%] male), median passes were 2 (IQR 1-3); 39 (37.9%) had 1 pass, 61 (59.2%) more than 1 and 3 (2.9%) recanalised without a thrombectomy pass. Multiple passes were associated with lower eTICI 2c-3 rates (30.0% vs 82.1%; P < .001), and worse 90-day mRS (common odds ratio 3.47; 95% CI, 1.63-7.38; P = .001). However, among patients achieving eTICI 2c-3 (n = 50), we detected no difference by pass count (mRS 0-2: 93.8% vs 94.4%; risk difference - 0.6%, 95% CI, -15% to +20%; P = 1.000). After accounting for eTICI, pass count was not independently associated with mRS > 2, while eTICI remained significant. CONCLUSIONS: In this analysis of the first-pass effect in paediatric thrombectomy, multiple passes were associated with worse functional outcomes, but this effect appeared to be largely mediated through recanalisation quality. Subgroup analyses were underpowered to exclude a clinically relevant residual effect of pass count, and these findings should be considered hypothesis-generating.
Source: European Stroke Journal
DOI: 10.1093/esj/aakag128
Authors: Adam A Dmytriw, Iman Kiani, Kartik Bhatia, Todd Abruzzo, Lisa Pabst, Stuart Fraser, Melissa G Chung, Warren Lo, Ahmed Othmann, Sebastian Steinmetz, Ulf Jensen-Kondering, Stefan Schob, Daniel P O Kaiser, Wolfgang Marik, Christina Wendl, Ilka Kleffner, Hans Henkes, Hermann Kraehling, Thi Dan Linh Nguyen-Kim, René Chapot, Umut Yilmaz, Furene Wang, Muhammad Ubaid Hafeez, Flavio Requejo, Nicola Limbucci, Birgit Kauffmann, Markus Möhlenbruch, Omid Nikoubashman, Peter D Schellinger, Franja Dugar, Patricia Musolino, Ali Alawieh, Jenny Wilson, Dominik Grieb, Alexandra S Gersing, Thomas Liebig, Martin Olivieri, Jaroslava Paulasova Schwabova, Ales Tomek, Panagiotis Papanagiotou, Grégoire Boulouis, Olivier Naggara, Christine K Fox, Kirill Orlov, Alexandra Kuznetsova, Carmen Parra-Farinas, Prakash Muthusami, Robert W Regenhardt, Mesha L Martinez, Daniel Brechbühl, Maja Steinlin, Lisa R Sun, Ameer E Hassan, Adrien Guenego, Andrew Molyneux, André Kemmling, Sarah Lee, Heather J Fullerton, Jens Fiehler, Marios-Nikos Psychogios, Moritz Wildgruber, Peter B Sporns
Institutions: Brigham and Women's Hospital, Harvard University, University of Oxford, Massachusetts General Hospital, Toronto Metropolitan University, Tehran University of Medical Sciences, The University of Sydney, Children's Hospital at Westmead, Barrow Neurological Institute, Phoenix Children's Hospital, University of Utah, The University of Texas Health Science Center at Houston, Nationwide Children's Hospital, The Ohio State University, Johannes Gutenberg University Mainz, University Medical Center of the Johannes Gutenberg University Mainz, University Hospital Schleswig-Holstein, University of Lübeck, University Hospital in Halle, University Hospital Carl Gustav Carus, Technische Universität Dresden, Medical University of Vienna, University Hospital Regensburg, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Katharinenhospital, Klinikum Stuttgart, University of Münster, University Hospital Münster, Stadtspital Zürich, Alfried Krupp Hospital, Universitätsklinikum des Saarlandes, National University Hospital, Baylor College of Medicine, Garrahan Hospital, Azienda Ospedaliero-Universitaria Careggi, Klinikum Bremen-Mitte, University Hospital Heidelberg, RWTH Aachen University, Johannes Wesling Klinikum Minden, Emory University, Oregon Health & Science University, Medizinische Hochschule Hannover, Sana Kliniken Duisburg, LMU Klinikum, Ludwig-Maximilians-Universität München, Charles University, University Hospital in Motol, National and Kapodistrian University of Athens, Aretaeio Hospital, Université de Tours, Inserm, Imaging, Brain, and Neuropsychiatry, Centre Hospitalier Universitaire de Tours, Hôpital Necker-Enfants Malades, Université Paris Cité, University of California, San Francisco, Federal Medical-Biological Agency, University of Toronto, Hospital for Sick Children, Texas Children's Hospital, University of Bern, Johns Hopkins University, Johns Hopkins Medicine, University Hospital of Bern, The University of Texas Rio Grande Valley, Erasmus Hospital, Universitair Ziekenhuis Brussel, Philipps University of Marburg, Stanford Medicine, Stanford University, University Medical Center Hamburg-Eppendorf, University Hospital of Basel
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,400
OpenAlex ID: W7223111871