Can the clock be stretched for stroke treatment? Would endovascular thrombectomy beyond 6 h improve outcomes in patients with clinical deficits out of proportion to the volume of infarct on imaging? The DAWN trial investigated the benefits of endovascular thrombectomy in patients with acute ischemic stroke treated between 6 and 24 h after symptom onset. The trial enrolled patients with a mismatch between clinical deficit severity and infarct size (clinical deficits out of proportion to the volume of infarct on imaging). The results demonstrated that endovascular thrombectomy significantly improved functional outcomes compared to standard medical therapy alone, with a higher proportion of patients achieving independence at 90 days. The trial established that selected patients, even with delayed presentation, could benefit from mechanical thrombectomy, challenging the conventional treatment window for stroke intervention.

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Thrombectomy at 6 to 24 Hours Following Stroke with Mismatch between Deficit and Infarct Size: The DAWN Trial

  • Jose Chacko,
  • Donald B. Chalfin,
  • Ian Seppelt,
  • Swapnil Pawar,
  • Gagan Brar

摘要

Can the clock be stretched for stroke treatment? Would endovascular thrombectomy beyond 6 h improve outcomes in patients with clinical deficits out of proportion to the volume of infarct on imaging? The DAWN trial investigated the benefits of endovascular thrombectomy in patients with acute ischemic stroke treated between 6 and 24 h after symptom onset. The trial enrolled patients with a mismatch between clinical deficit severity and infarct size (clinical deficits out of proportion to the volume of infarct on imaging). The results demonstrated that endovascular thrombectomy significantly improved functional outcomes compared to standard medical therapy alone, with a higher proportion of patients achieving independence at 90 days. The trial established that selected patients, even with delayed presentation, could benefit from mechanical thrombectomy, challenging the conventional treatment window for stroke intervention.