The combined angiographic technique during mechanical thrombectomy for predicting first-pass effect in patients with large artery occlusion: A retrospective observational cohort study

First pass effect (FPE), defined as single-pass complete or near-complete reperfusion during endovascular thrombectomy for large artery occlusion (LAO) strokes, is a significant performance metric, which is increasingly utilized to determine the success of mechanical thrombectomy (MT). To evaluate the value of the innovatively proposed combined angiographic technique (CAT) for predicting FPE in anterior circulation stroke patients with LAO. We retrospectively reviewed our prospectively collected data for anterior circulation LAO patients treated with MT between January 2019 and December 2022. FPE was defined as single pass of the device, near-complete/complete reperfusion of the LAO and its downstream territory (mTICI 2c/3) after MT, and no use of rescue therapy. The cohort was categorized into the FPE and non-FPE groups. Angiography is performed with an intermediate catheter and micro-catheter, which we refer to as the CAT, to determine the location and length of the thrombus body during the procedure. The sensitivity, specificity, and positive and negative predictive values of the CAT in predicting FPE were assessed. A total of 217 patients with anterior circulation occlusion were included in the final analysis. Among them, combined angiographic technique was conducted in 94 (43.3%) patients. Patients with FPE used the CAT prior to MT at a higher rate than those without FPE (69.2% vs 11.3%, P < .001). The sensitivity, specificity, positive predictive value, and negative predictive value of the CAT in predicting FPE were 69.2%, 88.6%, 88.3%, and 69.9%, respectively. Our study showed that the CAT is technically safe and easily applied in clinical practice, which may be helpful for neuro-interventionists to select the appropriate thrombectomy strategy and optimal material combination during the procedure. Further prospective multicenter studies need to validate this safe and efficient technique in a large patient cohort.