Per-pass analysis of recanalization and good neurological outcome in thrombectomy for stroke: Systematic review and meta-analysis

Jorge Arturo Larco, Mehdi Abbasi, Yang Liu, Sarosh Irfan Madhani, Adnan Hussain Shahid, Ramanathan Kadirvel, Waleed Brinjikji, Luis E. Savastano

Research output: Contribution to journalReview articlepeer-review


Background and aim: First pass effect (FPE) is defined as achieving a complete recanalization with a single thrombectomy device pass. Although clinically desired, FPE is reached in less than 30% of thrombectomy procedures. Multiple device passes are often necessary to achieve successful or complete recanalization. We performed a systematic review and meta-analysis to determine the recanalization rate after each pass of mechanical thrombectomy and its association with good neurological outcome. Methods: A literature search was performed for studies reporting the number of device passes required for either successful (mTICI 2b or higher) or complete (mTICI 2c or higher) recanalization. Using random-effect meta-analysis, we evaluated the likelihood of recanalization and good neurological outcome (measured with the modified Rankin Score <2 at 90 days) after each device pass. Results: Thirteen studies comprising 4197 patients were included. Among cases with failed first pass, 24% of them achieved final complete recanalization and 45% of them achieved final successful recanalization. Independently to the total number of previously failed attempts, the likelihood of achieving successful recanalization was 30% per pass, and the likelihood to achieve complete recanalization was about 20% per pass. The likelihood of good neurological outcome in patients with final successful recanalization decreased after each device pass: 55% after the first pass, 48% after the second pass, 42% after the third pass, 36% after the fourth pass, and 26% for 5 passes or more. Conclusion: Each pass is associated with a stable likelihood of recanalization but a decreased likelihood of good neurological outcome.

Original languageEnglish (US)
Pages (from-to)358-363
Number of pages6
JournalInterventional Neuroradiology
Issue number3
StatePublished - Jun 2022


  • Ischemic stroke
  • good neurological outcome
  • mRS 0-2 at 90 days
  • per pass
  • thrombectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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