See Tables XVII and XLV in online Data Supplement 1. 3.7.1. Concomitant With IV Alteplase (Continued) COR LOE New, Revised, or Unchanged Powers et al 2019 Guidelines for Management of AIS e373 Direct aspiration thrombectomy as first-pass mechanical thrombectomy is recommended as noninferior to stent retriever for patients who meet all the following criteria: (1) prestroke mRS score of 0 to 1; (2) causative occlusion of the internal carotid artery or M1; (3) age 18 years; (4) NIHSS score of 6; (5) ASPECTS 6; and (6) treatment initiation (groin puncture) within 6 hours of symptom onset. I B-R Recommendation revised from 2015 Endovascular. Comparative available randomized data has assessed patients primarily in the therapeutic window within 6 hours of onset. The COMPASS (Comparison of Direct Aspiration Versus Stent Retriever as a First Approach) trial randomized patients with (1) prestroke mRS score of 0 to 1; (2) causative occlusion of the internal carotid artery or M1; (3) age 18 years; (4) NIHSS score of 5; (5) ASPECTS 6; and (6) treatment can be initiated (groin puncture) within 6 hours of symptom onset to aspiration thrombectomy or stentriever thrombectomy as first-line technique. Primary outcome was noninferiority of mRS score at 90 days. An mRS score of 0 to 2 was achieved in 69 of 134 (52%) of patients in the aspiration group and 67 of 136 (50%) in the stentriever group, demonstrating noninferiority of aspiration thrombectomy compared with stentriever thrombectomy (Pnoninferiority =0.0014). No difference in recanalization rates or intracranial hemorrhage was found.192 The ASTER trial (Contact Aspiration vs Stent Retriever for Successful Revascularization) compared the contact aspiration technique and the standard stent retriever technique as first-line mechanical thrombectomy for successful revascularization within 6 hours among patients with acute anterior circulation ischemic stroke and LVO. 