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Thrombectomy 6 to 24 hours after stroke with deficit–infarct mismatch

One-paragraph summary

DAWN randomized 206 patients with intracranial ICA or proximal MCA occlusion, last known well 6–24 hours earlier, and age-adjusted clinical deficit–core mismatch. The trial stopped at a prespecified interim analysis. Utility-weighted mRS was 5.5 versus 3.4 (adjusted difference 2.0, 95% credible interval 1.1–3.0), and functional independence was 49% versus 13% (adjusted difference 33 percentage points, 95% credible interval 24–44). Symptomatic ICH was 6% versus 3% and mortality 19% versus 18% (PMID 29129157).

Key findings

  • 107 assigned thrombectomy, 99 standard care.
  • Treatment used clinical–core mismatch, not time alone.
  • Functional-independence absolute difference was 36 observed percentage points.
  • No significant symptomatic-ICH or mortality difference in this small selected sample.

Limitations

  • Highly selected small-core/large-deficit population; results do not apply to all late presenters.
  • Early stopping can inflate effect estimates.
  • Automated core estimates and workflows may not transfer to limited-imaging settings.

Why it matters

DAWN replaced a uniform wall clock with a tissue-informed clock for selected late presenters and made imaging logistics part of treatment efficacy.

Cited by wiki pages

  • overview
  • acute ischemic stroke
  • biomarkers and imaging markers
  • clinical trials landscape