Evidence map›Paper›PMID 42905746›Full record

ArticleEuropean stroke journal2026

Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study.

Adam A Dmytriw, Iman Kiani, Kartik Bhatia, Todd Abruzzo, Lisa Pabst, Stuart Fraser, Melissa G Chung, Warren Lo, Ahmed Othmann, Sebastian Steinmetz and 53 more

Abstract readMulticenter Study
In one paragraph

Article in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

63 authors.

Adam A DmytriwOxford Neurovascular and Neuroradiology Unit, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.
Iman KianiNeurointerventional & Neuroanalytics Consortium (NAN-C), School of Medicine, Toronto Metropolitan University, Toronto, Ontario, Canada.
Kartik BhatiaChildren's Hospital at Westmead Clinic School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Todd AbruzzoDepartment of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States.
Lisa PabstDivision of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States.
Stuart FraserDivision of Child and Adolescent Neurology, Department of Pediatrics, The University of Texas McGovern Medical School, Houston, TX, United States.
Melissa G ChungDivision 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.
Warren LoDepartment of Pediatrics and Department of Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, United States.
Ahmed OthmannDepartment of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
Sebastian SteinmetzDepartment of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
Ulf Jensen-KonderingDepartment of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany.
Stefan SchobDepartment of Radiology and Neuroradiology, University Hospital Halle, Halle, Germany.
Daniel P O KaiserInstitute of Neuroradiology, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
Wolfgang MarikDepartment of Neuroradiology, Medical University of Vienna, Vienna, Austria.
Christina WendlInstitute of Radiology, University Hospital Regensburg, Regensburg, Germany.
Ilka KleffnerDepartment of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.
Hans HenkesNeuroradiological Clinic, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
Hermann KraehlingClinic for Radiology, Department for Interventional Neuroradiology, University of Münster, Münster, Germany.
Thi Dan Linh Nguyen-KimDepartment of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland.
René ChapotDepartment of Neuroradiology, Alfried-Krupp-Krankenhaus, Essen, Germany.ORCID 0000-0002-2584-8361
Umut YilmazDepartment of Neuroradiology, Saarland University Hospital, Homburg, Germany.
Furene WangDepartment of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.
Muhammad Ubaid HafeezDepartment of Neurology, Baylor College of Medicine, Houston, TX, United States.
Flavio RequejoDepartment of Neuroradiology, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina.
Nicola LimbucciDepartment of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy.
Birgit KauffmannDepartment of Pediatrics and Adolescent Medicine, Eltern-Kind-Zentrum Prof Hess, Klinikum Bremen Mitte, Bremen, Germany.
Markus MöhlenbruchDepartment of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.ORCID 0000-0002-5075-704X
Omid NikoubashmanDepartment of Neuroradiology, Aachen University, Aachen, Germany.
Peter D SchellingerDepartment of Neurology and Neurogeriatrics, University Clinic of the Ruhr-Universität Bochum, Minden, Germany.
Franja DugarDepartment of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland.
Patricia MusolinoDepartment of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Ali AlawiehDepartment of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States.
Jenny WilsonDivision of Pediatric Neurology, Oregon Health & Science University, Portland, OR, United States.
Dominik GriebDepartment of Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany.
Alexandra S GersingDepartment of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany.
Thomas LiebigDepartment of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany.
Martin OlivieriPediatric Thrombosis and Hemostasis Unit, Dr von Hauner Children's Hospital, LMU Munich, Munich, Germany.
Jaroslava Paulasova SchwabovaDepartment of Paediatric Neurology, Comprehensive Stroke Center, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
Ales TomekDepartment of Neurology, Comprehensive Stroke Center, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
Panagiotis PapanagiotouDepartment of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany.
Grégoire BoulouisDiagnostic and Interventional Neuroradiology, CIC-IT 1415, Imaging Brain & Neuropsychiatry (iBraiN), UMR INSERM U1253, Tours University Hospital, Université de Tours, Tours, France.
Olivier NaggaraFrench Center for Pediatric Stroke, Paris, France.
Christine K FoxDepartment of Neurology and Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States.
Kirill OrlovResearch Center of Endovascular Neurosurgery, Federal Center of Brain Research and Neuro Technologies of FMBA, Moscow, Russia.
Alexandra KuznetsovaDivision of Neuroradiology and Division of Neurointervention, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.ORCID 0000-0002-0344-9765
Carmen Parra-FarinasDivision of Neuroradiology and Division of Neurointervention, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Prakash MuthusamiDivision of Neuroradiology and Division of Neurointervention, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.ORCID 0000-0002-7062-9571
Robert W RegenhardtDepartment of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Mesha L MartinezDepartment of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
Daniel BrechbühlDivision of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Maja SteinlinGraduate School for Health Sciences, University of Bern, Bern, Switzerland.
Lisa R SunDepartment of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
Ameer E HassanDepartment of Neurology, University of Texas Rio Grande Valley, Harlingen, TX, United States.
Adrien GuenegoDepartment of Interventional and Diagnostic Neuroradiology, Erasme University Hospital, Brussels, Belgium.
Andrew MolyneuxOxford Neurovascular and Neuroradiology Unit, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.ORCID 0000-0002-8757-9021
André KemmlingDepartment of Neuroradiology, University of Marburg, Marburg, Germany.
Sarah LeeDivision of Child Neurology, Department of Neurology, Stanford University, Stanford, CA, United States.
Heather J FullertonDepartment of Neurology and Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States.
Jens FiehlerDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.ORCID 0000-0001-8533-7478
Marios-Nikos PsychogiosDepartment of Neuroradiology, University Hospital Basel, Basel, Switzerland.
Moritz WildgruberDepartment of Radiology, LMU University Hospital, Munich, Germany.
Peter B SpornsDepartment of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland.
Save Child S Pro Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIn 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

methodsWe 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.

resultsOf 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.

conclusionsIn 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.

Indexed as

Endovascular ProceduresStrokeThrombectomyAdolescentChildChild, PreschoolFemaleHumansInfantMaleProspective StudiesRegistriesTreatment Outcomeendovascular thrombectomyfirst-pass effectpaediatric stroke

Identifiers

PMID42905746
PMCPMC13685784

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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.