Mount Sinai investigators led a trial demonstrating aspiration is equally effective, and significantly cheaper than, traditional stent retriever approach for clot removal as reported by EurekAlert! The press release noted “sucking a clot directly out of the artery in patients experiencing a stroke is just as effective as, and significantly cheaper than, removing it by use of a stent.” The trial was led by the Icahn School of Medicine at Mount Sinai with results published March 9 in the Lancet. Known as the COMPASS trial, concerned large vessel occlusion stroke, the most devastating kind of ischemic stroke. It compared the direct aspiration first pass (ADAPT) approach to the current standard of care—stent retriever first-line (SRFL), for mechanical clot removal (thrombectomy) in patients suffering acute ischemic strokes.
The data evidences the two approaches have comparable clinical results but that the aspirational approach is significantly more cost effective. The COMPASS trial enrolled 270 patients into prospective, randomized, open-label, blinded outcome assessment and core lab adjudicated trial to assess the clinical outcome of the patient—how they were after treatment with either ADAPT using a large-diameter aspiration catheter (ACE68™) system made by Penumbra Inc or an SRFL approach. Follow the link for more information on results.
Using pre-specified device-related procedural cost analyses, the COMPASS trial showed that the aspiration-first cohort had significantly lower device costs across all analysis methods. When using aggregate supply chain data as the primary source and list price as the secondary source, the aspiration-first group had a mean $4,541 reduction in the cost of devices used compared with the stent retriever first line group. When using list price as the primary source and aggregate supply chain data as the secondary source, the aspiration-first group had a mean $5,074 reduction in the cost of devices used. Furthermore, the reduction in median device costs was even greater ($6157.40 and $6,838, respectively) (p<0.0001 for all price comparisons).
J Mocco, MD, MS, Vice Chair of Neurosurgery and Director of the Cerebrovascular Center for the Mount Sinai Health System