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Original research
Clot perviousness is associated with first pass success of aspiration thrombectomy in the COMPASS trial
  1. Maxim Mokin1,2,
  2. Muhammad Waqas3,
  3. Johanna Fifi4,
  4. Reade De Leacy4,
  5. David Fiorella5,
  6. Elad I Levy3,6,
  7. Kenneth Snyder3,6,
  8. Ricardo Hanel7,
  9. Keith Woodward8,
  10. Imran Chaudry9,
  11. Ansaar T Rai10,
  12. Donald Frei11,
  13. Josser E Delgado Almandoz12,
  14. Michael Kelly13,
  15. Adam S Arthur14,15,
  16. Blaise W Baxter16,
  17. Joey English17,
  18. Italo Linfante18,
  19. Kyle M Fargen19,
  20. Aquilla Turk9,
  21. Adnan H Siddiqui3,6,
  22. J Mocco4
  1. 1 Neurosurgery, University of South Florida, Tampa, Florida, USA
  2. 2 Neurosciences Center, Tampa General Hospital, Tampa, Florida, USA
  3. 3 Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  4. 4 Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  5. 5 Neurosurgery and Radiology, Stony Brook University, New York, New York, USA
  6. 6 Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
  7. 7 Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
  8. 8 Vista Radiology, Knoxville, Tennessee, USA
  9. 9 Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
  10. 10 Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
  11. 11 Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
  12. 12 Neurointerventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
  13. 13 Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  14. 14 Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  15. 15 Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  16. 16 Lehigh Valley Health Network, Allentown, Pennsylvania, USA
  17. 17 California Pacific Medical Center, San Francisco, California, USA
  18. 18 Baptist Cardiac and Vascular Institute, Miami, Florida, USA
  19. 19 Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Maxim Mokin, Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33606, USA; mokin{at}


Background Clot density (Hounsfield units, HU) and perviousness (post-contrast increase in the HU of clot) are thought to be associated with clot composition. We evaluate whether these imaging characteristics were associated with angiographic outcomes of aspiration and stent retriever thrombectomy in COMPASS: a trial of aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion.

Methods Clot density and perviousness were measured by two independent operators who were blind to all the final angiographic and clinical outcomes. The association of clot density and perviousness with the Thrombolysis In Cerebral Infarction (TICI) scale after first pass was assessed using univariate and multivariate analysis.

Results Among all patients enrolled in COMPASS, 165 were eligible for the post-hoc analysis (81 patients in the aspiration first and 84 in the stent retriever first groups). Overall mean perviousness of clot was significantly higher in patient with mTICI 2b-3 after first pass (28.6±22.9 vs 20.3±19.2, p=0.017). Mean perviousness among patients who achieved TICI 2c/3 versus TICI 2b versus TICI 0-2a in the aspiration first group varied significantly (32.6±26.1, 35.3±24.4, and 17.7±13.1, p=0.013). The association of perviousness with first pass success was not significant in the stent retriever group. Using multivariate analysis, high perviousness (defined as cut-off >27.6) was an independent predictor of TICI 2b-3 (OR 3.82, 95% CI 1.10 to 13.19; p=0.034).

Conclusions Clot perviousness is associated with first pass angiographic success in patients treated with the aspiration first approach for thrombectomy.

  • CT angiography
  • thrombectomy
  • stroke

Data availability statement

Data are available upon reasonable request. Requests for data availability should be addressed to COMPASS principal investigators.

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Data availability statement

Data are available upon reasonable request. Requests for data availability should be addressed to COMPASS principal investigators.

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  • Contributors MM, MW, JM, AHS, AT– study concept and design. MM, MW wrote the manuscript. MM and CTP – statistical analysis. All authors edited the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MM: Grant NIH R21NS109575. Consultant; Medtronic, Canon medical, Cerenovus. Stock options: Serenity medical, Synchron, VICIS, Endostream. MW: None. JF: Consultant: Stryker, Penumbra, Microvention. Stock: Cerebrotech, The Stroke Project. RDL: Consultant: Penumbra, Cerenovus, Siemens. DF: Consultant: Penumbra, Cerenovus, Stryker, Genentech, Shape Memory Medical. EIL: 6; Consultant: Penumbra, NextGen Biologics, Rapid Medical, Cognition Medical, Three Rivers Medical, Stryker, MedX, Endostream Medical. KS Consultant: Penumbra, Canon Medical Systems, Medtronic, Jacobs Institute, Neurovascular Diagnostics. RH: Consultant: Penumbra, Endostream, Cerebrotech, Synchron, InNeuroCo, Medtronic, Microvention, Stryker, Cerenovus; Elum, Three Rivers. KW: Consultant: Penumbra. IC: Consultant: Medtronic, Microvention, Penumbra. Stock: Cerenovus, Serenity Medical, Cerebrotech, Three Rivers Medical, Q’apel. ATR: Consultant: Penumbra, Microvention, Stryker. DF: Consultant: Penumbra, Cerenovus, Stryker, Genentech, Shape Memory Medical, Siemens. JEDA: Consultant: Penumbra, Medtronic. MK: Consultant: Penumbra, Medtronic, Endostream. ASA: Consultant: Cerenovus, Medtronic, Microvention, Penumbra, Scientia, Siemens, Stryker. Stock: Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity, Synchron, Triad, Vascular Simulations. BWB: Consultant: Penumbra, Medtronic, Stryker, Cerenovus,, 880 medical, Route 92, Artio Medical. JE: Consultant: Penumbra, Medtronic, Stryker, Route 92 Medical. IL: Consultant: Penumbra, Medtronic, Stryker, Microvention, InNeuroCo, Three Rivers. KF: None. AT: Consultant: Cardinal Consulting, Cerenovus, Corindus, Medtronic, Siemens, 880 Medical. Stocks: Cerebrotech, Endostream. Imperative Care, Three Rivers Medical, Vastrax, Shape Memory, Synchron, Serenity Medical, Blink TBI, Echovate, RIST, Apama, Q’Apel, VizAi, Early Bird Medical, Rapid Medical, Spinnaker Medical. AHS: Stocks: Amnis Therapeutics, Apama Medical, BlinkTBI, Inc, Buffalo Technology Partners, Inc, Cardinal Health, Cerebrotech Medical Systems, Inc, Claret Medical, Cognition Medical, Endostream Medical, Ltd, Imperative Care, International Medical Distribution Partners, Rebound Therapeutics Corp, Silk Road Medical, StimMed, Synchron, Three Rivers Medical, Inc, Viseon Spine, Inc. Consultant/Advisory Board: Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA, Cerebrotech Medical Systems, Inc, Cerenovus, Claret Medical, Corindus, Endostream Medical, Ltd, Guidepoint Global Consulting, Imperative Care, Integra, Medtronic, MicroVention. JM: Stock options: Cerebrotech, Imperative Care, Endostream, Viseon, BlinkTBI, Serenity, Cardinal Consulting, NTI, RIST,, Synchron. Consultant: Imperative Care, Cerebrotech, VIseon, Endostream, Vastrax, RIST, Synchron,, Perflow, CVAid.

  • Provenance and peer review Not commissioned; externally peer reviewed.