Technique pioneered at MUSC fares well in clinical trial
A technique pioneered at the Medical University of South Carolina works at least as well as stent retrievers for mechanical thrombectomy in stroke patients with large-vessel clots, according to preliminary results of the COMPASS Trial. The results were presented today at the International Stroke Conference in Los Angeles. The technique is called ADAPT, short for A Direct Aspiration First-Pass Technique.
Stent retrievers, the current standard of care for mechanical thrombectomy in patients with acute ischemic stroke, are cage-like devices that are used to engage and then remove the clot. In contrast, ADAPT, which was developed by neuroendovascular surgeons Imran Chaudry, Alejandro Spiotta, Aquilla Turk and Raymond Turner, uses a large-diameter aspiration catheter (ACE68, Penumbra) to try to remove the clot entirely.
“The COMPASS trial provides Level 1 evidence that, in a head-to-head comparison, aspiration is at least as good as stent retrievers and, certainly to me, the way to start doing a thrombectomy procedure,” said Turk, the trial’s principal investigator. “You simply drive a catheter to the face of the clot, you attempt aspiration and, if it doesn’t work, then at that point you can add a stent retriever and have as good a result as with stent retrievers alone.”
The trial was conducted at MUSC, where Turk directs the neurointerventional surgery section in the Departments of Radiology and Neurosurgery. Collaborators on the trial include J. Mocco, vice chair of neurosurgery and director of the Cerebrovascular Center at the Icahn School of Medicine at Mount Sinai, New York, and Adnan Siddiqui, professor of neurosurgery at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.
The COMPASS trial enrolled 270 patients to assess how functional they were after treatment with either ADAPT or a stent retriever as the first-line approach.
The data show the ADAPT technique was comparable to stent retrievers for treatment of large-vessel occlusions. Fifty-two percent of the people treated with ADAPT achieved functional independence at 90 days, compared with 49 percent of patients treated with stent retrievers.
The COMPASS Trial reaffirmed the results of two previous multi-center trials showing improvements in procedure and technique while maintaining a strong safety profile and 90-day clinical outcomes. COMPASS is the first of the three randomized trials to study ADAPT using the ACE68 aspiration catheter.
Doctors say the simplicity of the technique suggests that it should reduce procedure times and costs. Turk will present the full results of the trial, including procedural and cost-effectiveness data, at the European Stroke Organisation Conference meeting in Gothenburg, Sweden in May.
The COMPASS trial was paid for by Penumbra, but the trial was conducted independently by Turk and his collaborators, who also handled all data analysis.