Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, January 31, 2018

Stent Retrievers and Aspiration On Par for Initial Thrombectomy Strategy

Once again lazy endpoints were chosen for the trial. Time to reperfusion rather than the correct endpoint of 100% recovery. So what if both parts were the same? the outcome is still a failure. Not getting to 100% recovery, that is the only goal.
https://www.medpagetoday.com/meetingcoverage/isc/70755?
Stroke functional outcomes don't differ in head-to-head trial
  • by Senior Associate Editor, MedPage Today
  • This article is a collaboration between MedPage Today® and:
    Medpage Today

LOS ANGELES -- Which mechanical thrombectomy tool clinicians reach for first in large vessel ischemic strokes may not make much difference in outcomes, the COMPASS trial showed.
Aspiration as the initial strategy was noninferior to initial stent retriever use for good functional outcomes at 90 days (52% versus 49% modified Rankin Scale score 0-2, Nor was there any differential shift in the overall Rankin scores, J Mocco, MD, of Mount Sinai Hospital in New York City, and colleagues reported here at the International Stroke Conference.
Time to substantial reperfusion and the quality of the reperfusion, in terms of proportion of blood flow restored, were statistically comparable between groups, although initial aspiration held consistent numerical advantages.
Safety was nearly identical between the two strategies for 90-day all-cause mortality and intracranial hemorrhage, both overall and symptomatic.
"Now we have level I evidence that stent retrievers and primary aspiration have equivalent clinical outcomes in large vessel occlusion," Mocco concluded at a press briefing for the late-breaking clinical trial session.
Ralph Sacco, MD, of the University of Miami and president of the American Academy of Neurology, said he wasn't so sure that the evidence has risen to what guidelines committees would consider class Ia.

He cautioned that noninferiority designs don't always prove equivalence. "I think it's grade A evidence. Is it level I? It's getting pretty close."
"The important thing is all of these tools are helpful, the question is what do you start with," he added. "What COMPASS unequivocally shows is you don't have to open the stent retriever. If you go up with the catheter, do aspiration, and that works ... then you're done. If it doesn't work, then you use that same catheter that is already up by the clot to put [in] the stent retriever and grab the clot."
The COMPASS "data are a bit more robust for aspiration compared to the previously, technically-driven trial, ASTER," he added. That French trial had shown closer similarity across endpoints than COMPASS, which Mocco suggested might be accounted for by newer devices and catheters in the latter.
While formal cost analysis of the trial has not yet been completed, press conference moderator Bruce Ovbiagle, MD, of the Medical University of South Carolina in Charleston, noted that this will be a factor in clinical choice as well.
The aspiration technique has been suggested as a less expensive approach, by eliminating need for a roughly $6,000 stent retriever device. In the aspiration-first arm of COMPASS, only 20.9% of patients received stent retriever treatment as a second device due to failure or in attempt to improve flow.

The proportion achieving at least substantial reperfusion (TICI 2b flow) with the primary modality was similar between groups (83.2% aspiration versus 81.3% stent retriever, P=0.75).
The investigator-initiated head-to-head trial included 270 patients randomized to the two treatment strategies at 15 centers, which were balanced between those doing mostly aspiration-first thrombectomy and those doing most cases stent-retriever first as well as a few with no clear preference.
Mocco cautioned that the data should be considered preliminary, as small changes may be made if one patient must be excluded due to consent problems that were just discovered and are under investigation by the group.
COMPASS was funded by Penumbra, although it played no role in the trial execution, data collection, or analysis.
Mocco disclosed relationships with Blockade Medical, Cardinal, Endostream, Rebound Medical, Apama, Viseon, 3Rivers Medical, Serenity, Synchron, Cerebrotech, and the Stroke Project.

  • Primary Source
  • International Stroke Conference
    Source Reference: Mocco J, et al "A comparison of direct aspiration vs. stent retriever as a first approach ('COMPASS'): A randomized trial" ISC 2018; Abstract LB4.

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