Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial

Turk, Aquilla S; Siddiqui, Adnan H.; Fifi, Johanna T; Leacy, Reade De; Fiorella, David; Gu, Eugene; Levy, Elad I.; Snyder, Kenneth V.; Hanel, Ricardó A.; Aghaebrahim, Amin; Woodward, B; Hixson, H; Chaudry, M Imran; Spiotta, Alejandro M; Ansaar, T; Frei, Donald; Almandoz, Josser E Delgado; Kelly, Michael; Arthur, Adam S; Baxter, Blaise; English, Joey; Linfante, Italo; Fargen, Kyle M; Mocco, J

doi:10.1016/s0140-6736(19)30297-1

“…This is most likely explained by the fact that difficult cases with insufficient reperfusion often involve the employment of multiple techniques. Furthermore, no differences were found in reperfusion success between patients treated exclusively with stent-retrievers or those treated with aspiration devices, as has also been reported by the COM-PASS trial [26], as well as by a recent meta-analysis [23]. In this context, it is of importance to note that recent studies have demonstrated that a combined approach, such as stent retriever-assisted vacuum-locked extraction (SAVE) appears to be superior in achieving reperfusion with a single pass [36].…”

supporting

confidence: 71%

Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke

Flottmann

¹

,

Broocks²,

Faizy

³

et al. 2020

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Aim In acute large vessel occlusions, endovascular therapy (EVT) achieves flow restoration in the majority of cases; however, EVT fails to achieve sufficient reperfusion in a substantial minority of patients. This study aimed to identify predictors of failed reperfusion. Methods In this study 2211 patients from the German Stroke Registry who received EVT for anterior circulation stroke were retrospectively analyzed. Failure of reperfusion was defined as thrombolysis in cerebral infarction (TICI) grades 0/1/2a, and sufficient reperfusion as TICI 2b/3. In 1629 patients with complete datasets, associations between failure of reperfusion and baseline clinical data, comorbidities, location of occlusion, and procedural data were assessed with multiple logistic regression. Results Failure of reperfusion occurred in 371 patients (16.8%) and was associated with the following locations of occlusion: cervical internal carotid artery (ICA, adjusted odds ratio, OR 2.01, 95% confidence interval, CI 1.08-3.69), intracranial ICA without carotid T occlusion (adjusted OR 1.79, 95% CI 1.05-2.98), and M2 segment (adjusted OR 1.86, 95% CI 1.21-2.84). Failed reperfusion was also associated with cervical ICA stenosis (>70% stenosis, adjusted OR 2.90, 95% CI 1.69-4.97), stroke of other determined etiology by TOAST (Trial of ORG 10172 in acute stroke treatment) criteria (e.g. nonatherosclerotic vasculopathies, adjusted OR 2.73, 95% CI 1.36-5.39), and treatment given outside the usual working hours (adjusted OR 1.41, 95% CI 1.07-1.86). Successful reperfusion was associated with higher Alberta stroke program early CT score (ASPECTS) on initial imaging (adjusted OR 0.85, 95% CI 0.79-0.92), treatment with the patient under general anesthesia (adjusted OR 0.72, 95% CI 0.54-0.96), and concomitant ICA stenting in patients with ICA stenosis (adjusted OR 0.20,). The authors Hannes Leischner and Caspar Brekenfeld contributed equally to the manuscript. Electronic supplementary material The online version of this article (https://doi.F. Flottmann et al. ConclusionSeveral factors are associated with failure of reperfusion, most notably occlusions of the proximal ICA and low ASPECTS on admission. Conversely, stent placement in the proximal ICA was associated with reperfusion success.

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“…Therefore, SR is recommended as a first-line device for treatment of large vessel occlusion in the AHA/ASA guidelines [2]. However, contact aspiration (CA) showed outcomes comparable to those with SR in recent studies [3,4].…”

Section: Introductionmentioning

confidence: 99%

Immediate Effects of First-line Thrombectomy Devices for Intracranial Atherosclerosis-Related Occlusion: Stent Retriever versus Contact Aspiration

Yoo

¹

,

Lee

²

,

Hong

³

et al. 2020

Preprint

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Background: Although stent retriever (SR) is recommended as a frontline device of endovascular treatment (EVT) for embolic large artery occlusion causing acute ischemic stroke, contact aspiration (CA) device showed similar efficacy in the recent trials. However, the efficacy of the both devices as first-line therapy for intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion has not yet been established. Therefore, we compared the immediate effects and final outcomes of SR and CA as first-line devices for treating ICAS-related occlusions.Methods: We retrospectively analyzed the data of patients who underwent EVT for acute ischemic stroke from the registry of three Korean hospitals. Patients with ICAS-related occlusion who were treated within 24 hours of onset of the symptoms were included. We investigated immediate reperfusion performance, immediate safety outcomes, and 3-month clinical outcomes for the two first-line devices.Results: Of the 720 registered patients, 111 were eligible for this study. Forty-nine patients (44.1%) used SR and 62 (55.9%) used CA as the first-line device. Achieving successful reperfusion immediately after first-line thrombectomy was more frequent in the SR group than that in the CA group (77.6% vs. 43.5%, p = 0.001), with fewer additional rescue treatments (12.2% vs. 59.7%, p < 0.001). The incidence of iatrogenic dissection or rupture was lower in the SR group than that in the CA group (8.2% vs. 29.0%, p = 0.012). After additional rescue treatments, however, the final successful reperfusion rate did not differ between the two groups (SR 87.8% vs. CA 77.4%, p = 0.247), and there was no significant difference in the 3-month good outcomes (modified Rankin Scale, p = 0.524).Conclusions: First-line SR thrombectomy showed higher immediate reperfusion and less vessel injury for ICAS-related occlusions than CA. However, there was no significant difference in the final reperfusion status or 3-month outcomes from additional rescue treatments.

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“…In the ASTER trial, the reperfusion success did not differ between CA and SR (mTICI score of 2b or 3, SR 67.7% vs. CA 63.0%) [3,21]. More recently, the COMPASS trial showed that rst-line CA treatment was not inferior to rst-line SR treatment with respect to good outcomes (mRS 0-2, SR 50% vs. CA 52%;non-inferiority margin absolute difference 15%; p noninferiority =0.0014) [4]. The secondary angiographic outcomes did not signi cantly differ between groups but tended to be better in CA rather than in SR in terms of the median time to successful reperfusion (SR 33 min vs. CA 22 min, p = 0.019).…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, SR is recommended as a rst-line device for treatment of large vessel occlusion in the AHA/ASA guidelines [2]. However, contact aspiration (CA) showed outcomes comparable to those with SR in recent studies [3,4].…”

Section: Introductionmentioning

confidence: 99%

Immediate Effects of First-line Thrombectomy Devices for Intracranial Atherosclerosis-Related Occlusion: Stent Retriever versus Contact Aspiration

Yoo

¹

,

Lee

²

,

Hong

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Although stent retriever (SR) is recommended as a frontline device of endovascular treatment (EVT) for embolic large artery occlusion causing acute ischemic stroke, contact aspiration (CA) device showed similar efficacy in the recent trials. However, the efficacy of the both devices as first-line therapy for intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion has not yet been established. Therefore, we compared the immediate effects and final outcomes of SR and CA as first-line devices for treating ICAS-related occlusions.Methods: We retrospectively analyzed the data of patients who underwent EVT for acute ischemic stroke from the registry of three Korean hospitals. Patients with ICAS-related occlusion who were treated within 24 hours of onset of the symptoms were included. We investigated immediate reperfusion performance, immediate safety outcomes, and 3-month clinical outcomes for the two first-line devices.Results: Of the 720 registered patients, 111 were eligible for this study. Forty-nine patients (44.1%) used SR and 62 (55.9%) used CA as the first-line device. Achieving successful reperfusion immediately after first-line thrombectomy was more frequent in the SR group than that in the CA group (77.6% vs. 43.5%, p = 0.001), with fewer additional rescue treatments (12.2% vs. 59.7%, p < 0.001). The incidence of iatrogenic dissection or rupture was lower in the SR group than that in the CA group (8.2% vs. 29.0%, p = 0.012). After additional rescue treatments, however, the final successful reperfusion rate did not differ between the two groups (SR 87.8% vs. CA 77.4%, p = 0.247), and there was no significant difference in the 3-month good outcomes (modified Rankin Scale, p = 0.524).Conclusions: First-line SR thrombectomy showed higher immediate reperfusion and less vessel injury for ICAS-related occlusions than CA. However, there was no significant difference in the final reperfusion status or 3-month outcomes from additional rescue treatments.

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Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial

Cited by 398 publications

References 21 publications

Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke

Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke

Immediate Effects of First-line Thrombectomy Devices for Intracranial Atherosclerosis-Related Occlusion: Stent Retriever versus Contact Aspiration

Immediate Effects of First-line Thrombectomy Devices for Intracranial Atherosclerosis-Related Occlusion: Stent Retriever versus Contact Aspiration

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