1054. Comparison of First-Line Direct Aspiration and Stent Retriever Mechanical Thrombectomy for Anterior Acute Ischemic Stroke

Authors: Michael Martini; Aquilla Turk, DO; David Fiorella, MD, PhD; Ricardo Hanel, MD, PhD; Donald Frei, MD; Josser Delgado Almandoz, MD; Adam Arthur, MD, MPH; Blaise Baxter, MD; Italo Linfante, MD; J Mocco, MD, MS; Reade DeLeacy, MD (New York, NY)

Introduction: Mechanical thrombectomy is efficacious for treating acute ischemic stroke (AIS) resulting from emergent large vessel occlusion (ELVO). COMPASS sought to compare revascularization rates and patient outcomes for direct aspiration and stent retriever thrombectomy. All COMPASS operators were required to submit a case log for their last 20 consecutive thrombectomies to qualify for the study. We report the results of these qualifying cases. Methods: Qualifying cases were treated between 2015 and 2016 at 15 high-volume stroke centers across the United States. Of the 20 cases submitted, it was required that at least 5 patients were treated with stent-retriever or aspiration thrombectomy. Patients with anterior occlusions were grouped based on the mechanical thrombectomy technique first performed for revascularization. Ordinal logistic regression assessed the effects of clinical variables on patient disability using 90-day modified Rankin Scale (mRS) scores. Results: A total of 274 patients with AIS ELVO were included, with revascularization data available for 257 patients. 102 patients were first treated with direct aspiration, 120 with stent-retriever, and 35 with an alternative technique. Adequate revascularization (TICI ³ 2B) was achieved in 93 direct aspiration cases (91.2%) with a mean 1.9 ± 1.9 passes taken to revascularize, and in 105 stent-retriever cases (87.5%) with mean 1.7 ± 1.0 passes. In patients treated with first-line aspiration, number of passes and intracranial hemorrhage were significant predictors of 90-day mRS. In patients treated with first-line stent-retriever, age and pre-procedure mRS were predictors of 90-day outcomes. Conclusion: Our data suggest that revascularization rates and 90-day mRS scores are not significantly different between first-line direct aspiration and first-line stent retriever.