Peer-reviewedCC BY-NCEuropean stroke journal
Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study.
40 affiliations
- 1Oxford Neurovascular and Neuroradiology Unit, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.
- 2Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
- 3Neurointerventional & Neuroanalytics Consortium (NAN-C), School of Medicine, Toronto Metropolitan University, Toronto, Ontario, Canada.
- 4Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- 5Children's Hospital at Westmead Clinic School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- 6Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States.
- 7Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, United States.
- 8Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States.
- 9Division of Child and Adolescent Neurology, Department of Pediatrics, The University of Texas McGovern Medical School, Houston, TX, United States.
- 10Division 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.
- 11Department of Pediatrics and Department of Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, United States.
- 12Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
- 13Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany.
- 14Department Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany.
- 15Department of Radiology and Neuroradiology, University Hospital Halle, Halle, Germany.
- 16Institute of Neuroradiology, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
- 17Department of Neuroradiology, Medical University of Vienna, Vienna, Austria.
- 18Institute of Radiology, University Hospital Regensburg, Regensburg, Germany.
- 19Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.
- 20Neuroradiological Clinic, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
- 21Clinic for Radiology, Department for Interventional Neuroradiology, University of Münster, Münster, Germany.
- 22Department of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland.
- 23Department of Neuroradiology, Alfried-Krupp-Krankenhaus, Essen, Germany.
- 24Department of Neuroradiology, Saarland University Hospital, Homburg, Germany.
- 25Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.
- 26Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
- 27Department of Neuroradiology, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina.
- 28Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy.
- 29Department of Pediatrics and Adolescent Medicine, Eltern-Kind-Zentrum Prof Hess, Klinikum Bremen Mitte, Bremen, Germany.
- 30Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
- 31Department of Neuroradiology, Aachen University, Aachen, Germany.
- 32Department of Neurology and Neurogeriatrics, University Clinic of the Ruhr-Universität Bochum, Minden, Germany.
- 33Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
- 34Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States.
- 35Division of Pediatric Neurology, Oregon Health & Science University, Portland, OR, United States.
- 36Department of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
- 37Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany.
- 38Department of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany.
- 39Pediatric Thrombosis and Hemostasis Unit, Dr von Hauner Children's Hospital, LMU Munich, Munich, Germany.
- 40Department of Paediatric Neurology, Comprehensive Stroke Center, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
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.
Related
- Causal discovery and treatment effect heterogeneity of futile recanalisation (CADISTH) for large vessel occlusion stroke: protocol and rationale for a multicentre prospective cohort study
- Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in paediatric surgery: the VIDEOKIDS pragmatic international multicentre randomised trial study protocol.
- Mechanical thrombectomy for superior sagittal sinus thrombosis in early pregnancy: a case report
- Central retinal artery occlusion preceding hemispheric ischemic stroke treated with mechanical thrombectomy : A case report
- Thrombophilic Variants and Clinical Outcomes in Young Ischaemic Stroke Patients Undergoing Mechanical Thrombectomy: A Retrospective Cohort Study
BibTeX
@article{dmytriw2026recanalisation,
title = {{Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study.}},
author = {Adam A Dmytriw and Iman Kiani and Kartik Bhatia and Todd Abruzzo and Lisa Pabst and Stuart Fraser and Melissa G Chung and Warren Lo and Ahmed Othmann and Sebastian Steinmetz and Ulf Jensen-Kondering and Stefan Schob and Daniel P O Kaiser and Wolfgang Marik and Christina Wendl and Ilka Kleffner and Hans Henkes and Hermann Kraehling and Thi Dan Linh Nguyen-Kim and René Chapot and Umut Yilmaz and Furene Wang and Muhammad Ubaid Hafeez and Flavio Requejo and Nicola Limbucci and Birgit Kauffmann and Markus Möhlenbruch and Omid Nikoubashman and Peter D Schellinger and Franja Dugar and Patricia Musolino and Ali Alawieh and Jenny Wilson and Dominik Grieb and Alexandra S Gersing and Thomas Liebig and Martin Olivieri and Jaroslava Paulasova Schwabova and Ales Tomek and Panagiotis Papanagiotou and Grégoire Boulouis and Olivier Naggara and Christine K Fox and Kirill Orlov and Alexandra Kuznetsova and Carmen Parra-Farinas and Prakash Muthusami and Robert W Regenhardt and Mesha L Martinez and Daniel Brechbühl and Maja Steinlin and Lisa R Sun and Ameer E Hassan and Adrien Guenego and Andrew Molyneux and André Kemmling and Sarah Lee and Heather J Fullerton and Jens Fiehler and Marios-Nikos Psychogios},
journal = {European stroke journal},
year = {2026},
month = oct,
doi = {10.1093/esj/aakag128},
url = {https://europepmc.org/article/MED/42905746},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study.
AU - Adam A Dmytriw
AU - Iman Kiani
AU - Kartik Bhatia
AU - Todd Abruzzo
AU - Lisa Pabst
AU - Stuart Fraser
AU - Melissa G Chung
AU - Warren Lo
AU - Ahmed Othmann
AU - Sebastian Steinmetz
AU - Ulf Jensen-Kondering
AU - Stefan Schob
AU - Daniel P O Kaiser
AU - Wolfgang Marik
AU - Christina Wendl
AU - Ilka Kleffner
AU - Hans Henkes
AU - Hermann Kraehling
AU - Thi Dan Linh Nguyen-Kim
AU - René Chapot
AU - Umut Yilmaz
AU - Furene Wang
AU - Muhammad Ubaid Hafeez
AU - Flavio Requejo
AU - Nicola Limbucci
AU - Birgit Kauffmann
AU - Markus Möhlenbruch
AU - Omid Nikoubashman
AU - Peter D Schellinger
AU - Franja Dugar
AU - Patricia Musolino
AU - Ali Alawieh
AU - Jenny Wilson
AU - Dominik Grieb
AU - Alexandra S Gersing
AU - Thomas Liebig
AU - Martin Olivieri
AU - Jaroslava Paulasova Schwabova
AU - Ales Tomek
AU - Panagiotis Papanagiotou
AU - Grégoire Boulouis
AU - Olivier Naggara
AU - Christine K Fox
AU - Kirill Orlov
AU - Alexandra Kuznetsova
AU - Carmen Parra-Farinas
AU - Prakash Muthusami
AU - Robert W Regenhardt
AU - Mesha L Martinez
AU - Daniel Brechbühl
AU - Maja Steinlin
AU - Lisa R Sun
AU - Ameer E Hassan
AU - Adrien Guenego
AU - Andrew Molyneux
AU - André Kemmling
AU - Sarah Lee
AU - Heather J Fullerton
AU - Jens Fiehler
AU - Marios-Nikos Psychogios
PY - 2026
DA - 2026/10/01
JO - European stroke journal
DO - 10.1093/esj/aakag128
UR - https://europepmc.org/article/MED/42905746
AB - 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.
SN - 2396-9873
SN - 2396-9881
ER -