First-pass success in mechanical thrombectomy lowers costs in treatment of acute ischemic stroke in Asia Pacific

Findings from a CERENOVUS study shed light on the positive impact the first-pass effect can have on improving patient outcomes and reducing economic costs

SINGAPORE, April 1, 2021 /PRNewswire/ — A recent study published in the Journal of Stroke (JOS) has found that in the treatment of acute ischemic stroke, achieving complete or near complete reperfusion after a single attempt with mechanical thrombectomy (MT) not only provides improved functional outcomes for patients, but may also lower healthcare spending in the Asia Pacific region[1].

Globally, over 13 million people experience a stroke each year,[4] which is expected to increase by 34% over the next 15 years.[5] With Asia Pacific home to 60% of the world’s population, countries in the region are already experiencing a significant share in the burden of this medical condition. Healthcare costs associated with stroke across several Asia Pacific economies, including Thailand, China, Singapore and Australia, stand at US$38.2 billion annually, representing between 0.2% and 2.6% of their respective GDP.[6]

Against this backdrop, the Health Economic Impact of First Pass Success: An Asia-Pacific Cost Analysis of the ARISE II Study evaluates the implications of achieving first-pass effect (FPE) on the costs of hospitalization and long-term care in patients with acute ischemic stroke across Australia, India, Japan, South Korea, Singapore, and Taiwan.

FPE, defined as the complete or near complete reperfusion in a single thrombectomy pass, is an established indicator of technical and clinical efficacy among MT techniques,[5] and should be the procedural goal in stroke treatment.[2] Based on published studies, achieving first-pass complete reperfusion helps to shorten procedural time and reduces the risk of vessel injury and irritation.[3]

In addition to improved functional outcomes, achieving FPE has the potential to generate significant cost savings throughout the continuum of care. The study found that FPE reduced the length of inpatient stay by 3.38 days, required fewer devices and procedural-related costs fell by almost a third across all countries. The cost-savings reported in the study range from US$5,951 in Australia to US$3,981 in Singapore. The study further concluded that patients were able to reduce health expenditure on long-term care, particularly in countries such as Japan (US$2,941) and South Korea (US$5,084).[1]

Commenting on the findings, lead author Dr Leonard Yeo Leong Litt shared, "Improving patient outcomes is always at the heart of any advancement in healthcare – and when it has the ability to reduce the cost of care, for the individual and system at hand, that’s when the impact becomes even greater."  

This economic analysis is based on a post-hoc analysis of data from ARISE II,[5] paired with cost data from six countries in Asia Pacific. It is the first study quantifying the economic impact associated with improved functional outcomes when achieving FPE in the treatment of acute ischemic stroke. ARISE II, a prospective single-arm international multi-center clinical trial, investigated the efficacy of MT using the EMBOTRAP® Revascularization Device in 227 patients.

The trial demonstrated a high FPE success of 40%[5] while typical rates are closer to 28%, as reported in a recent meta-analysis.[7]

The full Yeo et al. publication can be accessed here:


CERENOVUS, part of Johnson & Johnson Medical Devices Companies, is a global leader in neurovascular care. Our commitment to changing the trajectory of stroke is inspired by our long heritage and dedication to helping physicians protect people from a lifetime of hardship. CERENOVUS offers a broad portfolio of devices used in the endovascular treatment of hemorrhagic and ischemic stroke. For more information, visit and connect on LinkedIn and Twitter.

About Johnson & Johnson Medical Devices Companies 

As the world’s most comprehensive medical devices business, we are building on a century of experience, merging science and technology, to shape the future of health and benefit even more people around the world. With our unparalleled breadth, depth and reach across surgery, orthopedics, vision and interventional solutions, we’re working to profoundly change the way care is delivered. We are in this for life. For more information, visit



1)  Yeo L., Zaidat O.O., Saver J.L., Mattle H.P., et al. Health Economic Impact of First Pass Success: An Asia-Pacific Cost Analysis of the ARISE II Study. Journal of Stroke. (accessed March 2021)

2)  Zaidat O.O., Castonguay A.C., Lifante I., et al. First Pass Effect. A New Measure for Stroke Thrombectomy Devices. Stroke. 2018;49:660-666. 

3) Nikoubashman O., Dekeyzer S., Riabikin A., et al. True First-Pass Effect. First-Pass Complete Reperfusion Improves Clinical Outcome in Thrombectomy Stroke Patients. Stroke. 2019;50:2149-2146.

4)  World Stroke Organization. Learn about stroke. Available at: (accessed 17 November 2020).

5)  Zaidat O.O., Bozorgchami H., Ribo M., et al. Primary Results of the Multicenter ARISE II Study (Analysis of Revascularization in Ischaemic Stroke with EmboTrap). Stroke. 2018;48:1107-1115.

6) EIU Healthcare. The cost of inaction: secondary prevention of cardiovascular disease in Asia-Pacific. Available at: (accessed 2 March 2021).

7) Abbasi M., Liu Y., Fitzgerald S., et al. Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes. Journal of NeuroInterventional Surgery. 2021;0:1–6.


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