Observational studyStroke2021
Good Clinical Outcome Decreases With Number of Retrieval Attempts in Stroke Thrombectomy: Beyond the First-Pass Effect.
Observational study in Stroke, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT03356392 (German Stroke Registry - Endovascular Treatment), which is not on this map. Cited by 54 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
German Stroke Registry - Endovascular Treatment
Who cites it
54 citing papers in PubMed, 2 syntheses or guidelines pooled it, 87 citations in OpenAlex.
- 2b Or 2c-3? A meta-analysis of first pass thrombolysis in cerebral infarction 2b vs multiple pass thrombolysis in cerebral infarction 2c-3 following mechanical thrombectomy for stroke.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2026Pooled it
- Per-pass analysis of recanalization and good neurological outcome in thrombectomy for stroke: Systematic review and meta-analysis.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2022Pooled it
- Methylprednisolone as Adjunct to Thrombectomy for Acute Intracranial Internal Carotid Artery Occlusion Stroke: Post Hoc Secondary Analysis of the MARVEL Randomized Clinical Trial.JAMA network open · 2025Trial
- Number of Retrieval Attempts and the Association of Intravenous Tirofiban with Symptomatic Intracranial Hemorrhage in Patients with Successful Endovascular Therapy: Results of the RESCUE BT Trial.Clinical interventions in aging · 2024Trial
- Redefining First Pass in the New Era of Super-Large-Bore Aspiration Catheters.Clinical neuroradiology · 2026Article
- Combined stent retriever and contact aspiration improves first-line recanalisation but not clinical outcomes: a pooled analysis of the ASTER, ASTER2, and VECTOR trials.European stroke journal · 2026Article
- The effect of distal aspiration catheter position on collateral flow in mechanical thrombectomy - anInterventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2026Article
- Mechanical Thrombectomies Requiring an Increased Number of Passes are Associated with Unfavorable Angiographic Outcomes.Arquivos de neuro-psiquiatria · 2026Article
- Impact of First-pass Effect for M2 Segment of Middle Cerebral Artery Occlusion.Neurologia medico-chirurgica · 2026Article
- Impact of device pass count and reperfusion levels in anterior circulation stroke: differential effects based on large-scale data from clinical practice.Journal of neurology · 2025Article
- The use of the NeVa stent-retriever for bail-out mechanical thrombectomy.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Key to better outcomes in stroke intervention: early versus complete reperfusion in first pass recanalization.Journal of neurology · 2025Observational
- NIMBUS geometric clot extractor for challenging clots: Real-world clinical experience and clot composition.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Machine learning-based forecasting of daily acute ischemic stroke admissions using weather data.NPJ digital medicine · 2025Article
- Comparison of early versus late rescue stenting after failed thrombectomy for intracranial atherosclerosis-related large vessel occlusion.Acta neurochirurgica · 2025Article
- The prognostic significance of hyperdense middle cerebral artery sign in cardioembolic stroke patients undergoing mechanical thrombectomy.BMC neurology · 2025Article
- Echocardiographic predictors of futile recanalization in acute ischemic stroke.Revista da Associacao Medica Brasileira (1992) · 2025Article
- Iatrogenic arterial vasospasm during mechanical thrombectomy requiring treatment with intra-arterial nimodipine might be associated with worse outcomes.European journal of neurology · 2024Observational
- True first-pass effect in patients undergoing thrombectomy for acute large core strokes.Annals of clinical and translational neurology · 2024Article
- A Deep Learning Approach to Predict Recanalization First-Pass Effect following Mechanical Thrombectomy in Patients with Acute Ischemic Stroke.AJNR. American journal of neuroradiology · 2024Article
Corrections and comments
- Erratum issued
Authors and funding
14 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeEndovascular therapy is the standard of care in the treatment of acute ischemic stroke due to large-vessel occlusion. Often, more than one retrieval attempt is needed to achieve reperfusion. We aimed to quantify the influence of endovascular therapy on clinical outcome depending on the number of retrievals needed for successful reperfusion in a large multi-center cohort.
methodsFor this observational cohort study, 2611 patients from the prospective German Stroke Registry included between June 2015 and April 2018 were analyzed. Patients who received endovascular therapy for acute anterior circulation stroke with known admission National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score, final Thrombolysis in Cerebral Infarction score, and number of retrievals were included. Successful reperfusion was defined as a Thrombolysis in Cerebral Infarction score of 2b or 3. The primary outcome was defined as functional independence (modified Rankin Scale score of 0-2) at day 90. Multivariate mixed-effects models were used to adjust for cluster effects of the participating centers and confounders.
resultsThe inclusion criteria were met by 1225 patients. The odds of good clinical outcome decreased with every retrieval attempt required for successful reperfusion: the first retrieval had the highest odds of good clinical outcome (adjusted odds ratio, 6.45 [95% CI, 4.0-10.4]), followed by the second attempt (adjusted odds ratio, 4.56 [95% CI, 2.7-7.7]), and finally the third (adjusted odds ratio, 3.16 [95% CI, 1.8-5.6]).
conclusionsSuccessful reperfusion within the first 3 retrieval attempts is associated with improved clinical outcome compared with patients without reperfusion. We conclude that at least 3 retrieval attempts should be performed in endovascular therapy of anterior circulation strokes. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03356392.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.