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Updated: Jan 28, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
First-Pass Effect With Aspiration Thrombectomy With the Penumbra System in Patients With Acute Ischemic Stroke: A
Johanna T Fifi1, Stavros Matsoukas1, Ameer E Hassan2
1Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York NY.
Background:
In patients with acute ischemic stroke, minimizing the time to revascularization can minimize neuronal death. First-pass effect (FPE), defined as successful or complete revascularization of an occluded target vessel with 1 pass of a mechanical thrombectomy device(s), reduces the time to revascularization. The objective of this study was to determine the FPE rate, compare cases in which FPE was versus was not achieved, and determine predictors of good functional outcome at 90 days, in patients with large-vessel occlusion acute ischemic stroke treated with the Penumbra System (Penumbra, Inc).
Methods:
This study is a subset analysis of the COMPLETE (International Acute Ischemic Stroke Registry With the Penumbra System Aspiration Including the 3D [3-Dimensional] Revascularization Device) registry, a global, prospective, multicenter, observational registry. FPE rates were calculated. Subgroups who achieved versus did not achieve FPE were compared. Variables independently associated with good functional outcome at 90 days were determined.
Results:
A total of 648 patients were included. FPE was achieved with a revascularization definition of modified thrombolysis in cerebral infarction score 2b to 3 in 56.8% of patients, with modified thrombolysis in cerebral infarction score 2c to 3 in 41.5%, and with modified thrombolysis in cerebral infarction score 3 in 31.8%. The percentage of patients who achieved good functional outcome at 90 days was higher for patients who achieved FPE than for patients who did not (P<0.01). Achieving FPE with modified thrombolysis in cerebral infarction score 2b to 3 was an independent predictor for good functional outcome at 90 days (adjusted odds ratio, 1.64; P=0.045).
Conclusions:
For aspiration thrombectomy with the Penumbra System, achieving FPE was associated with a significantly higher rate of good functional outcome.
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