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目的:探讨首次再通效应对采用国产支架取栓治疗的急性前循环颅内大血管闭塞患者临床预后的影响，以及实现首次再通效应的影响因素。方法:选择3项前瞻性、多中心、开放、随机对照临床试验（REDIRECT试验、Tonbridge试验、CAPTURE试验）中采用国产支架取栓治疗的223例急性前循环颅内大血管闭塞患者。根据术后90 d改良Rankin量表（mRS）评分，将患者分为预后良好组（mRS评分≤2分，131例）与预后不良组（mRS评分>2分，92例），比较2组患者基线资料和手术参数的差异，并采用多因素Logistic回归分析筛选患者预后的独立影响因素。根据是否获得首次再通效应[一次支架取栓实现闭塞血管完全再通（改良脑梗死溶栓分级（mTICI）3级）]，将患者分为首次再通效应组（69例）与非首次再通效应组（154例），比较2组患者基线资料和手术参数的差异，并采用多因素Logistic回归分析分析筛选患者获得首次再通效应的独立影响因素。结果:（1）预后良好组患者的年龄、入院时美国国立卫生研究院卒中量表（NIHSS）评分、短暂性脑缺血发作比例、房颤比例、责任闭塞血管为颈内动脉者比例、发病至入院时间、发病至股动脉穿刺时间、股动脉穿刺至血管再通时间均明显低于预后不良组，预后良好组患者的首次再通效应比例明显高于预后不良组，差异均有统计学意义（ P<0.05）。多因素Logistic回归分析显示，大脑中动脉闭塞（ OR=0.459，95% CI：0.247~0.854， P=0.014）、首次再通效应（ OR=2.485，95% CI：1.282~4.816， P=0.007）、入院时NIHSS评分（ OR=0.894，95% CI：0.837~0.955， P=0.001）、股动脉穿刺至血管再通时间（ OR=0.993，95% CI：0.987~0.999， P<0.001）是患者预后良好的独立影响因素。（2）首次再通效应组股动脉穿刺至支架取栓完成时间明显低于非首次再通效应组，应用球囊导引导管（BGC）比例明显高于非首次再通效应组，差异均有统计学意义（ P<0.05）。多因素Logistic回归分析显示，应用BGC是首次再通效应的独立影响因素（ OR=3.185，95% CI：1.494~6.791， P=0.003）。 结论:应用国产支架治疗急性前循环颅内大血管闭塞时实现首次再通效应可以提高患者的临床预后，而应用BGC更有利于实现国产支架取栓的首次再通效应。

Objective:To investigate the influence of first pass effect (FPE) in prognoses of patients with acute intracranial large vessel occlusion in anterior circulation accepted mechanical thrombectomy with domestic stent retriever, and the influencing factors for FPE.Methods:A total of 223 patients with acute intracranial large vessel occlusion in anterior circulation accepted mechanical thrombectomy with domestic stent retriever were selected from 3 prospective, multicenter, open, randomized controlled clinical trials (REDIRECT trial, Tonbridge trial, CAPTURE trial). According to modified Rankin Scale (mRS) scores 90 d after thrombectomy, these patients were divided into good prognosis group (mRS scores≤2, n=131) and poor prognosis group (mRS scores>2, n=92); these patients were also divided into FPE group ( n=69) and non-FPE group ( n=154) according to whether FPE was achieved (complete recanalization with single stent retriever, modified Thrombolysis in Cerebral Infarction [mTICI] 3); differences in baseline data and surgical parameters between the 2 groups were compared; multivariate Logistic regression was used to analyze the independent influencing factors. Results:(1) Patients in the good prognosis group had significantly younger age, significantly lower National Institute of Health stroke scale (NIHSS) scores at admission, transient ischemic attack ratio, atrial fibrillation ratio and ratio of internal carotid artery as responsible occlusive vessel, statistically shorter time from onset to admission, time from onset to femoral artery puncture and time from femoral artery puncture to vascular recanalization compared with those in the poor prognosis group ( P<0.05); FPE proportion in the good prognosis group was significantly higher than that in the poor prognosis group ( P<0.05). Multivariate Logistic regression analysis showed that middle cerebral artery occlusion ( OR=0.459, 95% CI: 0.247-0.854, P=0.014), and FPE ( OR=2.485, 95% CI: 1.282-4.816, P=0.007), NIHSS score at admission ( OR=0.894, 95% CI: 0.837-0.955, P=0.001), time from femoral artery puncture to vascular recanalization ( OR=0.993, 95% CI: 0.987-0.999, P<0.001) were independent influencing factors for good prognosis. (2) The FPE group had significantly shorter time from femoral artery puncture to stent thrombectomy and higher proportion of balloon guided catheter (BGC) than the non-FPE group ( P<0.05). Multivariate Logistic regression analysis showed that BGC application was an independent influencing factor for FPE ( OR=3.185, 95% CI: 1.494-6.791, P=0.003). Conclusion:FPE can improve prognosis of patients with acute intracranial large vessel occlusion in anterior circulation accepted mechanical thrombectomy with domestic stent retriever, and BGC application helps FPE.