Mechanical thrombectomy of acute ischemic stroke caused by major vessel occlusion of the anterior circulation has become an accepted procedure in the last decade. Recent IAT modalities have been classified as suction aspiration,stent retrieval and combination modality. The suction aspiration technique is limited by the possibility of breaking the entire thrombus during the IAT. In addition, the stent retrieval technique is also limited because of thrombus migration during stent removal from an acute-angled artery as in the case of a carotid siphon. According to recent development of suction catheter, investigators expected that suction aspiration will prevent breaking the entire thrombus during the IAT. Investigators will evaluate the radiological and clinical outcome of suction aspiration technique in comparison with combination technique in the large artery occlusion feasible to both suction aspiration and combination technique prospectively in a randomized trial.
\*Hospital code for the participant hospitals Bundang Cha Hospital (A) Inje University Haeundae Paik Hospital(I) Samsung Medical Center Sungkyunkwan University (B) Kosin University Gospel Hospital (C) Daegu Good morning Hospital (D) Yeungnam University Medical Center (E) Pohang S hospital(G) Inje University Ilsan Paik Hospital(H) SM christianity Pohang Hospital(L) Choongnam National University Hospital(N) Inha University Hospital(P) Catholic University of Korea Bucheon ST. Mary's Hospital (Q) Catholic University of Korea Uijeongbu ST. Mary's Hospital (R) Catholic University of Korea ST. Vincent's Hospital (S) Ulsan University Hospital (U) Alphabetic number of each hospital is an each hospital code. If the patient with acute cerebral infarction will be feasible to suction aspiration and combination technique, the investigator who can enroll the patient should check the order of random table in open chatting board and perform the ordered method after completion of consent for the COMPETE trials. Each investigator in the hospitals participated in COMPETE trials will write the competetrials spread sheet on google web. The image files of thrombectomy including pre-thrombectomy and post-thrombectomy will be converted to zip file and send to the independent neurointerventional radiologist on e-mail about 2 \~ 4 times a year. the independent examiner will re-send to the investigator after completion of modified TICI grade in the image files of thrombectomy. This study should not enroll atherosclerotic tandem occlusion. Other etiologies such as cancer related stroke or dissection should not be enrolled in this study. Cases of Atherosclerotic steno-occlusion will be included in this study. Rescue treatment such as primary stenting or conventional modality will be performed according to the favored modality of each investigator.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
1,132
mechanical thrombectomy of acute ischemic stroke caused by major vessel occlusion of the anterior circulation has become an accepted procedure in the last decade.
Inje University Ilsan Paik Hospital
Goyang-si, Gyeonggi-do, South Korea
Bundang Cha Hospital
Seongnam-si, Gyeonggi-do, South Korea
Samsung Medical Center Sungkyunkwan University
Changwon, Gyeongsangnam-do, South Korea
The Catholic University of Korea, Bucheon ST. Mary's Hospital
Bucheon-si, South Korea
Daegu Goodmorning Hospital
Daegu, South Korea
Yeungnam University Medical Center
Daegu, South Korea
Chungnam National University Hospital.
Daejeon, South Korea
Inha University Hospital
Incheon, South Korea
Pohang S hospital
Pohang, South Korea
Pohang SM christianity Hospital
Pohang, South Korea
...and 3 more locations
Radiological outcome using modified TICI grade (mTICI)
modified TICI grade is composed of 0, 1, 2a,2b,2c, and 3. O of modified TICI grade is no recanalized state. 3 of modified TICI grade is completely recanalized state.
Time frame: time of control angiography after retrieval of thrombectomy devices
clinical outcome using modified Rankin Scale(mRS)
modified Rankin scale is composed of 0,1,2,3,4,5, and. Oof mRS is no neurological deficit. 6 of mRS is mortality case.
Time frame: 3 months after thrombectomy
Radiological outcome caused by cardioembolism using using modified TICI grade (mTICI)
modified TICI grade is composed of 0, 1, 2a,2b,2c, and 3. O of modified TICI grade is no recanalized state. 3 of modified TICI grade is completely recanalized state.
Time frame: time of control angiography after retrieval of thrombectomy devices
clinical outcome cause by cardioembolism using modified Rankin Scale(mRS)
modified Rankin scale is composed of 0,1,2,3,4,5, and. Oof mRS is no neurological deficit. 6 of mRS is mortality case.
Time frame: 3 months after thrombectomy
radiological outcome in M1 occlusion using modified TICI grade (mTICI)
modified TICI grade is composed of 0, 1, 2a,2b,2c, and 3. O of modified TICI grade is no recanalized state. 3 of modified TICI grade is completely recanalized state.
Time frame: time of control angiography after retrieval of thrombectomy devices
clinical outcome in M1 occlusion using modified Rankin Scale(mRS)
modified Rankin scale is composed of 0,1,2,3,4,5, and. Oof mRS is no neurological deficit. 6 of mRS is mortality case.
Time frame: 3 months after thrombectomy
radiological outcome in M2 occlusion using modified TICI grade (mTICI)
modified TICI grade is composed of 0, 1, 2a,2b,2c, and 3. O of modified TICI grade is no recanalized state. 3 of modified TICI grade is completely recanalized state.
Time frame: time of control angiography after retrieval of thrombectomy devices
clinical outcome in M2 occlusion using modified Rankin Scale(mRS)
modified Rankin scale is composed of 0,1,2,3,4,5, and. Oof mRS is no neurological deficit. 6 of mRS is mortality case.
Time frame: 3 months after thrombectomy
comparison of clinical outcome 3 months after IAT between mismatch more than 1/2 based on flow/volume of CT perfusion and calculated volume of mismatch using modified Rankin Scale(mRS)
modified Rankin scale is composed of 0,1,2,3,4,5, and. Oof mRS is no neurological deficit. 6 of mRS is mortality case.
Time frame: 3 months after thrombectomy
comparison of radiological outcome between more than 1/2 based on flow/volume of CT perfusion and calculated volume of mismatch based on flow/volume of CT perfusion
modified TICI grade is composed of 0, 1, 2a,2b,2c, and 3. O of modified TICI grade is no recanalized state. 3 of modified TICI grade is completely recanalized state.
Time frame: time of control angiography after retrieval of thrombectomy devices
comparison of radiological outcome between rescue treatment of primary stenting and sequential treatment in large artery atherosclerotic steno-occlusion using modified TICI grade (mTICI)
modified TICI grade is composed of 0, 1, 2a,2b,2c, and 3. O of modified TICI grade is no recanalized state. 3 of modified TICI grade is completely recanalized state.
Time frame: time of control angiography after retrieval of thrombectomy devices
comparison of clinical outcome 3 months after IAT between rescue treatment of primary stenting and sequential treatment in large artery atherosclerotic steno-occlusion using modified Rankin Scale(mRS)
modified Rankin scale is composed of 0,1,2,3,4,5, and. Oof mRS is no neurological deficit. 6 of mRS is mortality case.
Time frame: 3 months after thrombectomy
comparison of door-to-puncture time between hot-line prehospital tele-communication and conventional group
time interval between emergent room arrival time and femoral puncture
Time frame: time interval from ER arrival time to femoral puncture
comparison of radiological outcome between hot-line prehospital tele-communication and conventional group using modified TICI grade (mTICI)
modified TICI grade is composed of 0, 1, 2a,2b,2c, and 3. O of modified TICI grade is no recanalized state. 3 of modified TICI grade is completely recanalized state.
Time frame: time of control angiography after retrieval of thrombectomy devices
comparison of clinical outcome 3 months after IAT between hot-line prehospital tele-communication and conventional group using modified Rankin Scale(mRS)
modified Rankin scale is composed of 0,1,2,3,4,5, and. Oof mRS is no neurological deficit. 6 of mRS is mortality case.
Time frame: 3 months after thrombectomy
switching rate
switching rate from combination technique to suction aspiration technique
Time frame: time of switching from combination technique to suction aspiration
switching rate
switching rate from suction aspiration technique to combination technique
Time frame: time of switching from suction aspiration to combination technique
recanalization failure rate
recanalization failure rate of IAT
Time frame: time of final control angiogram immediately after thrombectomy
procedure related complication
procedural morbidity and mortality rate
Time frame: admission period
non-procedural morbidity and mortality rate
non-procedure related events and death such as myocardial infarction, pneumonia, or sepsis
Time frame: admission period
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