Mechanical Thrombectomy of an Embolic Middle Cerebral Artery/M1 Occlusion: First-Pass Effect in Acute Large Vessel Occlusion

Complete or near-complete reperfusion of large vessel occlusion (LVO) is the goal of thrombectomy. Reperfusion of LVO in only one pass (first-pass reperfusion, FPR) is associated with a better clinical outcome, called first-pass effect (FPE), and it can be considered the goal of the endovascular treatment of LVO, when achievable. We describe a representative case of FPE in a 77-year-old female patient with a cardioembolic acute occlusion of right MCA/M1, with atrial fibrillation that suspended anticoagulation before a scheduled surgery. After one-pass thrombectomy with a stent retriever and distal aspiration, reperfusion was achieved. First-pass reperfusion, with complete regression of neurological deficit and a good clinical outcome (FPE), is the topic of this chapter.