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

Clinical Snapshot

Key Findings

• P Value: Not applicable - protocol paper

• Effect Size: Not applicable - protocol paper

• Primary Outcome: Protocol study - results not yet available

• Nnt Or Sensitivity: Not applicable - protocol paper

• Confidence Interval: Not applicable - protocol paper

Clinical Application

Both techniques are standard of care in comprehensive stroke centers with appropriate expertise and equipment Highly relevant to Australian stroke services; mechanical thrombectomy is funded under Medicare for eligible patients and both techniques are used in Australian comprehensive stroke centers Patients with acute ischemic stroke due to large vessel occlusion suitable for mechanical thrombectomy

Abstract

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).

References

1. 1.Lee, J., Sheen, S. H., Jin, S. C., Choi, Y., Hyun, D., Shim, Y. S., Kim, T., Bae, J., Kim, C. H., Kwon, M. Y., Choi, Y. J., Hong, D., Kim, Y., Jeong, E. O., Kwon, H. J., Lee, Y., Lee, J., Ryu, S., Goh, D. H., Kim, S. Y., Kwon, S. C., Lee, J. M., Koo, H. W., Jung, Y., Kim, J., Chang, C. H., Oh, J. S., Kim, Y. W., Baek, J., & Kim, K. W. (2026). Comparison of Clinical and Radiological Outcomes Between Suction Aspiration and Combination Methods of Mechanical Thrombectomy in Patients With Acute Cerebral Infarction: The COMPETE Trial. Journal of Korean Medical Science, 41, e164. https://doi.org/10.3346/jkms.2026.41.e164