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

Multiple clinical trials have demonstrated the clinical benefit of mechanical thrombectomy and established thrombectomy as standard of care for appropriate patients, predominantly with use of stent retriever. This is a multicentre, randomized, blinded outcome, non-inferiority trial evaluating the use of aspirational thrombectomy as a first-line approach for large vessel occlusion. The study included 15 sites. Eligible patients presented with acute ischemic stroke from anterior circulation LVO within 6 hours of onset of symptoms. Trial protocol requested sites perform 3 passes with the assigned approach, in the setting of persistent occlusion, providers were able to use any approach according to physician preference.

270 patients were randomized for treatment, 134 to aspiration first pass and 136 to stent retriever. Median time to TICI 2B or greater reperfusion was 11 minutes faster in the aspiration first pass group. The primary efficacy endpoint of mRS of 0-2 at 90 days was achieved by 69 patients (52%; 95% CI 43·8–60·3) in the aspiration group and 67 patients (50%; 41·6–57·4) in the stent retriever group, demonstrating that aspiration first pass was non-inferior to stent-retriever. There was no significant difference in mortality or prespecified safety outcomes between treatment arms. Cost analysis also demonstrated lower device costs for an aspiration first pass approach.

https://doi.org/10.1016/S0140-6736(19)30297-1