Aspiration thrombectomy with the Penumbra System for patients with stroke and late onset to treatment: a subset analysis of the COMPLETE registry

Contrary to their bleating this was obviously a failure since no mention is made of 100% recovery. I don't accept their tyranny of low expectations that recanalization is the end goal of survivors; 100% recovery is the only goal in stroke! Why aren't you measuring that?

Aspiration thrombectomy with the Penumbra System for patients with stroke and late onset to treatment: a subset analysis of the COMPLETE registry

Ameer E. Hassan^1* Johanna T. Fifi² Osama O. Zaidat³

• ¹Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX, United States
• ²Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
• ³Department of Endovascular Neurosurgery, Mercy Health St. Vincent Medical Center, Toledo, OH, United States

Background: The purpose of this study was to report the safety and performance of aspiration thrombectomy with the Penumbra System for patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO) and late onset to treatment.

Methods: This is a retrospective subset analysis of a global prospective multicenter registry (COMPLETE) that enrolled adults with AIS due to LVO and a pre-stroke modified Rankin Scale score (mRS) of 0 or 1 who were treated first-line with aspiration thrombectomy either alone (A Direct Aspiration First Pass Technique [ADAPT]) or in combination with the 3D Revascularization Device (ADAPT + 3D). This subset analysis included all patients in the registry who had anterior circulation LVO, an Alberta Stroke Program Early CT Score of at least 6, and late onset to treatment (>6 h from stroke onset to puncture).

Results: Of the 650 patients in the COMPLETE registry, 167 were included in this subset analysis. The rate of successful revascularization (Since you don't mention 100% recovery, the only conclusion possible is complete failure!)(modified thrombolysis in cerebral infarction score 2b-3 achieved) at the end of the procedure was 83.2%, the rate of good functional outcome (mRS 0–2) at 90 days was 55.4%, and the all-cause mortality rate at 90 days was 14.4%. No device-related serious adverse events (SAEs) occurred. Procedure-related SAEs occurred in 9 patients (5.4%) within 24 h and in 12 patients (7.2%) overall. The rate of successful revascularization was higher for patients treated first-line with ADAPT (88.0%) than for patients treated first-line with ADAPT + 3D (75.0%; p = 0.035); no significant difference was observed between the ADAPT and ADAPT + 3D groups for any other primary or secondary outcome.

Conclusion: For patients with AIS due to anterior circulation LVO and with late onset to treatment, aspiration thrombectomy with the Penumbra System appears to be safe and effective. (Nope, nope, nope!) The rates of good functional outcome and all-cause mortality from this study compared favorably with those rates from the medical management arms of the DAWN and DEFUSE-3 studies.

Clinical trial registration: https://www.clinicaltrials.gov, NCT03464565.

The Use and Utility of Aspiration Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

This is suctioning the clot thru the catheter.You'll have to ask your stroke hospital what system they are using to remove clots and the efficacy of that system. Hopefully before you get to the emergency room. Those statistics should be publicly available so we can boycott those stroke hospitals that aren't any good.
http://www.docguide.com/use-and-utility-aspiration-thrombectomy-acute-ischemic-stroke-systematic-review-and-meta-analysis?hash=7e422beb&eid=59271&alrhash=3c9ebc-5aeefe0d7ed0a73e6788dca4998df39c

Wei D, Mascitelli J, Nistal D, Kellner C, Fifi J, Mocco J, De Leacy R; American Journal of Neuroradiology (AJNR) (Jul 2017)

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• Stroke

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BACKGROUND Thrombectomy trials are often specifically interpreted as evidence for the effectiveness of stent retrievers. The effectiveness of other thrombectomy techniques such as aspiration thrombectomy should be validated through further investigation and review.
PURPOSE To evaluate published treatment times and clinical outcomes in patients treated with aspiration thrombectomy or ADAPT (A Direct Aspiration, First Pass Technique) for acute ischemic stroke.
DATA SOURCES A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Scopus, and the Cochrane trial register were searched on November 8, 2016.
STUDY SELECTION Twenty studies (n = 1523 patients) were included in this review and meta-analysis. One of these studies was prospective, and the rest were retrospective.
DATA ANALYSIS Meta-analysis was performed by using a random effects model. Data and publication bias were visualized with forest plots and funnel plots.
DATA SYNTHESIS Five studies investigated aspiration thrombectomy only, and 16 studies investigated ADAPT. Of the 16 studies on ADAPT, the rate of successful recanalization (TICI 2b/3) was 89.3% (95% CI, 85.4%-92.3%). The proportion of patients with good clinical outcome (90-day mRS ≤2) was 52.7% (95% CI, 48.0%-57.4%).
LIMITATIONS Studies on ADAPT were retrospective, and there was heterogeneity between studies for successful recanalization (P<.001) and good clinical outcome (P<.001). There was evidence of publication bias for recanalization rates (P = .01), but not for clinical outcomes (P = .42).
CONCLUSIONS ADAPT and aspiration thrombectomy are effective approaches to thrombectomy, with high recanalization rates and excellent clinical outcomes reported in the literature. Aspiration thrombectomy is a promising neurointervention, but large prospective randomized studies are needed to validate its utility.