Comparison of Clinical and Radiological Outcomes Between Suction Aspiration and Combination Methods of Mechanical Thrombectomy in Patients With Acute Cerebral Infarction: The COMPETE Trial

BACKGROUND: Recent advances in suction catheter technology suggest that suction aspiration may prevent thrombus fragmentation during mechanical thrombectomy. We therefore hypothesize that the radiological outcomes of suction aspiration as a first-line treatment would not be inferior to those of the combination technique. This study aims to evaluate the radiological and clinical outcomes of first-line suction aspiration compared with those of the first-line combination technique for large artery occlusion amenable to both modalities. METHODS: The COMPETE trial is a prospective, randomized, multicenter, noninferiority, open-label trial. A total of 1,136 patients will be randomized at a 1:1 ratio to either the suction aspiration or combination technique groups. RESULTS: The primary endpoints are successful recanalization (modified Thrombolysis in Cerebral Infarction scale score ≥ 2b) and a good clinical outcome (modified Rankin Scale score of 0-2) at 90 days after thrombectomy. The technical outcome is the switching rate from the combination technique to suction aspiration and from suction aspiration to the combination technique. The safety outcomes include procedural morbidity, nonprocedural morbidity, procedural mortality, and nonprocedural mortality. CONCLUSION: The COMPETE trial is expected to determine whether the use of suction aspiration as a first-line approach in patients with acute ischemic stroke is noninferior to the combination technique in achieving successful radiological and good clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06254755; CRIS (KCT0007726).