"Thrombectomy 6 to 24 Hours after Stroke". The New England Journal of Medicine. 2017.
Links to original sources: Wiki Journal Post Full Journal Article
Does endovascular thrombectomy performed 6 to 24 hours after the onset of ischemic stroke improve outcomes in patients with a mismatch between the severity of the clinical deficit and the infarct volume?
Thrombectomy plus standard care resulted in better 90-day outcomes for disability and functional independence compared to standard care alone in patients with acute stroke who were treated 6 to 24 hours after last being known well and had a mismatch between clinical deficit and infarct volume.
Previous trials showed endovascular thrombectomy to be beneficial when performed within 6 hours post-acute stroke. The DAWN trial extended the potential therapeutic window for thrombectomy to 6-24 hours post-stroke in patients with a clinical-infarct mismatch, using advanced imaging to identify viable brain tissue.
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Multicenter, randomized, open-label trial with a Bayesian adaptive–enrichment design and blinded endpoint assessment.
Patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who were last known well 6 to 24 hours prior and had a mismatch between the severity of clinical deficit and infarct volume.
Patients were randomized to thrombectomy plus standard care (thrombectomy group) or standard care alone (control group).
The coprimary endpoints were the mean disability score on the utility-weighted modified Rankin scale at 90 days and the rate of functional independence at 90 days. Secondary endpoints included early therapeutic response, infarct volume, and recanalization rates.
- Variance in baseline characteristics between groups although sensitivity analyses confirmed the benefit of thrombectomy. - Sample size limited the power of certain subgroup analyses. - Frequency of general anesthesia in thrombectomy cases was only 10%.
The trial was funded by Stryker Neurovascular.
Not addressed within the wiki's content.