Impact of Reperfusion Quality and Pass Number on Functional Outcomes in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

OBJECTIVE: To compare functional outcomes between patients achieving good reperfusion (eTICI 2B) after a single pass and those requiring multiple passes to achieve excellent or complete reperfusion (eTICI 2C/3) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). METHODS: This single-center retrospective cohort study included 301 AIS patients with large vessel occlusion who underwent MT between January 2018 and December 2022. Patients were categorized into single-pass eTICI 2B (n = 65) and multiple-pass eTICI 2C/3 (2-5 passes, n = 214; >5 passes, n = 22). Functional outcomes were assessed at 90 days using the modified Rankin Scale. Early neurological deterioration, adverse events, and safety outcomes were also analyzed. RESULTS: No significant difference was observed in a 90-day functional independence between single-pass eTICI 2B and multiple-pass eTICI 2C/3 (47.7% vs. 41.5%, P = 0.39 for 2-5 passes; 27.3% vs. 41.5%, P = 0.24 for >5 passes). However, patients requiring more than 5 passes to achieve eTICI 2C/3 had significantly higher rates of early neurological deterioration (40.9% vs. 18.5%, P = 0.04) and adverse events (63.6% vs. 38.5%, P = 0.04). Mortality rates were similar between groups. CONCLUSIONS: Our study suggests that achieving eTICI 2C/3 through multiple passes does not result in improved functional outcomes compared to single-pass eTICI 2B. Moreover, extended thrombectomy procedures may increase the risk of early neurological deterioration and adverse events, highlighting the need for careful procedural strategy in MT for AIS patients.