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  • For patients with acute ischemic stroke, endovascular thrombectomy within six

  • hours after the onset of symptoms can improve outcomes. Patients with a

  • disproportionately high NIH Stroke score given the size of the ischemic area on

  • perfusion imaging (so called "clinical infarct mismatch") are more likely to

  • recover function after thrombectomy. The DAWN trial tested whether patients in

  • whom brain imaging showed proximal anterior cerebral vessel occlusion and

  • clinical infarct mismatch would benefit from thrombectomy 6 to 24 hours after

  • the onset of an ischemic stroke. Two hundred six patients were randomly assigned to

  • receive thrombectomy or standard medical care. The patients were then assessed at

  • 90 days after stroke. The primary outcome of post-stroke disability on the Utility-

  • Weighted modified Rankin Scale showed a mean score of 5.5 for the

  • thrombectomy group versus 3.4 for the standard care group, a

  • statistically significant difference. Functional independence was achieved in

  • 49% of patients in the thrombectomy group versus 13%

  • in the standard care group. Procedural complications occurred in

  • 7% of patients in the thrombectomy group. The rate of other

  • adverse events, such as symptomatic intracranial hemorrhage and death, was

  • similar between groups. The trial was stopped at 31 months when a

  • planned interim analysis showed the superiority of thrombectomy. The authors

  • conclude that in patients with acute anterior circulation stroke with

  • clinical-infarct mismatch, thrombectomy performed within six to 24 hours

  • significantly reduced disability and improved functional independence at

  • 90 days as compared with standard medical care. Full trial results are

  • available at NEJM.org.

For patients with acute ischemic stroke, endovascular thrombectomy within six

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B1 US stroke mismatch clinical standard group trial

Improving Outcomes in Stroke

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    Ching Chung posted on 2018/01/06
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