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 (eTICI), with underpowered subgroup analyses making the findings hypothesis-generating.
Most paediatric EVT patients in the registry required more than one thrombectomy pass, and only about 38% achieved first-pass reperfusion.
Multiple passes were associated with lower rates of complete/near-complete reperfusion (eTICI 2c-3).
Multiple passes were associated with worse ordinal 90-day functional outcome in the overall cohort.
Among patients who achieved eTICI 2c-3, pass count showed no difference in functional outcome.
After adjusting for eTICI grade, pass count was not independently associated with poor outcome (mRS > 2), whereas eTICI remained significant.
The authors conclude that recanalisation quality, rather than first-pass effect per se, appears to drive outcomes, but the findings are hypothesis-generating because of limited power.
In adults treated with clot-removal procedures (thrombectomy) for stroke, getting the clot out on the first attempt is linked to better recovery. This study asked whether the same is true for children. It analysed 103 children and teenagers from an international registry who underwent thrombectomy, looking at the number of device passes, how well blood flow was restored, and disability at 90 days. Children who needed more than one pass had worse outcomes overall and were much less likely to reach complete or near-complete restoration of blood flow (30% versus 82%). However, among the 50 children who did achieve complete or near-complete reperfusion, outcomes were about equally good (roughly 94% with little or no disability) whether it took one pass or several. After accounting for how well blood flow was restored, the number of passes no longer showed an independent link to outcome. This research suggests that the quality of the final restoration of blood flow may matter more than how many attempts it takes. However, the study was small, and the subgroup analyses were too limited to rule out a real effect of pass count, so the authors describe the results as hypothesis-generating and in need of confirmation in larger studies.
Dmytriw A, Kiani I, Bhatia K, Abruzzo T, Pabst L, Fraser S, et al.. (2026). Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study.. European stroke journal. https://doi.org/10.1093/esj/aakag128