{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:39:56Z","timestamp":1792600796311,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In adult endovascular thrombectomy (EVT), first-pass success is associated with better outcomes, but whether this \u201cfirst-pass effect\u201d also holds true in childhood stroke remains unknown. We investigated the association of thrombectomy pass counts with 90-day outcomes after paediatric EVT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>We analysed prospectively collected data from the international Save ChildS Pro registry (ages 0\u201317\u00a0years). All EVT-treated patients were included irrespective of the reperfusion grade achieved. Successful reperfusion was defined as expanded thrombolysis in cerebral infarction (eTICI) \u2265 2b and complete\/near-complete reperfusion as eTICI 2c\u20133. 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\u20133. Logistic regression for mRS &amp;gt;\u20092 was fitted with pass count and eTICI grade as covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 103 patients (median age 11\u00a0years [IQR 6\u201315]; 55\/102 [53.9%] male), median passes were 2 (IQR 1\u20133); 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\u20133 rates (30.0% vs 82.1%; P\u00a0&amp;lt;\u00a0.001), and worse 90-day mRS (common odds ratio 3.47; 95% CI, 1.63\u20137.38; P\u00a0=\u00a0.001). However, among patients achieving eTICI 2c\u20133 (n\u00a0=\u00a050), we detected no difference by pass count (mRS 0\u20132: 93.8% vs 94.4%; risk difference\u00a0\u2212\u00a00.6%, 95% CI, \u221215% to +20%; P\u00a0=\u00a01.000). After accounting for eTICI, pass count was not independently associated with mRS &amp;gt;\u20092, while eTICI remained significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/aakag128","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:50:42Z","timestamp":1792597842000},"source":"Crossref","is-referenced-by-count":0,"title":["Recanalisation quality, not first-pass effect, drives outcomes in paediatric mechanical thrombectomy: a multicentre prospective study"],"prefix":"10.1093","volume":"11","author":[{"given":"Adam A","family":"Dmytriw","sequence":"first","affiliation":[{"name":"Oxford Neurovascular and Neuroradiology Unit, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford , Oxford ,","place":["United Kingdom"]},{"name":"Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women\u2019s Hospital, Harvard Medical School , Boston, MA ,","place":["United States"]},{"name":"Neurointerventional & Neuroanalytics Consortium (NAN-C), School of Medicine, Toronto Metropolitan University , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iman","family":"Kiani","sequence":"additional","affiliation":[{"name":"Neurointerventional & Neuroanalytics Consortium (NAN-C), School of Medicine, Toronto Metropolitan University , Toronto, Ontario ,","place":["Canada"]},{"name":"Students\u2019 Scientific Research Center, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kartik","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital at Westmead Clinic School, Faculty of Medicine and Health, University of Sydney , Sydney ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd","family":"Abruzzo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ ,","place":["United States"]},{"name":"Department of Radiology, Phoenix Children\u2019s Hospital , Phoenix, AZ ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Pabst","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, UT ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Fraser","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Neurology, Department of Pediatrics, The University of Texas McGovern Medical School , Houston, TX ,","place":["United 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,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University , Mainz ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Jensen-Kondering","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein , Kiel ,","place":["Germany"]},{"name":"Department Neuroradiology, University Medical Center Schleswig-Holstein , L\u00fcbeck ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Schob","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology, University Hospital Halle , Halle ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P 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