{
  "abstract": "Introduction\n\nIn 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\n\nWe 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\n\nOf 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\n\nIn 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.",
  "abstract_shown": true,
  "affiliations": [
    "Oxford Neurovascular and Neuroradiology Unit, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.",
    "Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.",
    "Neurointerventional & Neuroanalytics Consortium (NAN-C), School of Medicine, Toronto Metropolitan University, Toronto, Ontario, Canada.",
    "Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.",
    "Children's Hospital at Westmead Clinic School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.",
    "Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States.",
    "Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, United States.",
    "Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States.",
    "Division of Child and Adolescent Neurology, Department of Pediatrics, The University of Texas McGovern Medical School, Houston, TX, United States.",
    "Division of Critical Care Medicine and Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, United States.",
    "Department of Pediatrics and Department of Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, United States.",
    "Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.",
    "Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany.",
    "Department Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany.",
    "Department of Radiology and Neuroradiology, University Hospital Halle, Halle, Germany.",
    "Institute of Neuroradiology, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.",
    "Department of Neuroradiology, Medical University of Vienna, Vienna, Austria.",
    "Institute of Radiology, University Hospital Regensburg, Regensburg, Germany.",
    "Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.",
    "Neuroradiological Clinic, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.",
    "Clinic for Radiology, Department for Interventional Neuroradiology, University of Münster, Münster, Germany.",
    "Department of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland.",
    "Department of Neuroradiology, Alfried-Krupp-Krankenhaus, Essen, Germany.",
    "Department of Neuroradiology, Saarland University Hospital, Homburg, Germany.",
    "Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.",
    "Department of Neurology, Baylor College of Medicine, Houston, TX, United States.",
    "Department of Neuroradiology, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina.",
    "Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy.",
    "Department of Pediatrics and Adolescent Medicine, Eltern-Kind-Zentrum Prof Hess, Klinikum Bremen Mitte, Bremen, Germany.",
    "Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.",
    "Department of Neuroradiology, Aachen University, Aachen, Germany.",
    "Department of Neurology and Neurogeriatrics, University Clinic of the Ruhr-Universität Bochum, Minden, Germany.",
    "Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.",
    "Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States.",
    "Division of Pediatric Neurology, Oregon Health & Science University, Portland, OR, United States.",
    "Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.",
    "Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany.",
    "Department of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany.",
    "Pediatric Thrombosis and Hemostasis Unit, Dr von Hauner Children's Hospital, LMU Munich, Munich, Germany.",
    "Department of Paediatric Neurology, Comprehensive Stroke Center, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 63,
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      "name": "Flavio Requejo"
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      "name": "Nicola Limbucci"
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        28
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      "name": "Birgit Kauffmann"
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      "name": "Markus Möhlenbruch",
      "orcid": "0000-0002-5075-704X"
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        30
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      "name": "Omid Nikoubashman"
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      "name": "Peter D Schellinger"
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      "name": "Franja Dugar"
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      "name": "Patricia Musolino"
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      "name": "Ali Alawieh"
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      "name": "Jenny Wilson"
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      "name": "Dominik Grieb"
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    {
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      "name": "Alexandra S Gersing"
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    {
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        37
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      "name": "Thomas Liebig"
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    {
      "affs": [
        38
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      "name": "Martin Olivieri"
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    {
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        39
      ],
      "name": "Jaroslava Paulasova Schwabova"
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    {
      "name": "Ales Tomek"
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    {
      "name": "Panagiotis Papanagiotou"
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    {
      "name": "Grégoire Boulouis"
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    {
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      "orcid": "0000-0002-0344-9765"
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      "name": "Robert W Regenhardt"
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      "name": "Andrew Molyneux",
      "orcid": "0000-0002-8757-9021"
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      "name": "André Kemmling"
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      "name": "Sarah Lee"
    },
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      "name": "Heather J Fullerton"
    },
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      "name": "Jens Fiehler",
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  "bibtex": "https://research.draconitic.com/paper/0jcy6gj18x6d2.bib",
  "cited_by": 0,
  "doi": "10.1093/esj/aakag128",
  "fulltext_url": "https://europepmc.org/articles/PMC13685784",
  "id": "0jcy6gj18x6d2",
  "issns": [
    "2396-9873",
    "2396-9881"
  ],
  "landing_url": "https://europepmc.org/article/MED/42905746",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Acute Ischemic Stroke Management"
    ]
  ],
  "openalex": "W7223111871",
  "pdf_url": "https://europepmc.org/articles/PMC13685784?pdf=render",
  "pmcid": "PMC13685784",
  "pmid": "42905746",
  "published": "2026-10-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0jcy6gj18x6d2.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42905746",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42905746"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Acute Ischemic Stroke Management",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study.",
  "title_text": "Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:57Z",
  "url": "https://research.draconitic.com/paper/0jcy6gj18x6d2",
  "venue": "European stroke journal",
  "versions": []
}