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Thrombectomy 24 hours after stroke: beyond DAWN.

Shashvat M Desai1, Diogo C Haussen2, Amin Aghaebrahim3

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|May 30, 2018
PubMed
Summary

Mechanical thrombectomy for acute stroke is effective even when performed beyond 24 hours in select patients meeting DAWN trial criteria. Outcomes for these extended window large vessel occlusion (LVO) stroke patients were comparable to the DAWN trial arm.

Keywords:
interventionstrokethrombectomy

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Area of Science:

  • Neurology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • The DAWN trial established thrombectomy benefits for acute stroke with large vessel occlusion (LVO) within 6-24 hours.
  • Patient selection for thrombectomy often relies on strict time windows.

Purpose of the Study:

  • To evaluate the characteristics and outcomes of patients meeting DAWN criteria but treated with thrombectomy >24 hours from time last known well (TLKW).
  • To assess the safety and feasibility of extended window thrombectomy in LVO stroke.

Main Methods:

  • Retrospective review of thrombectomy databases at three stroke centers.
  • Identification of patients meeting DAWN criteria treated >24 hours TLKW.
  • Comparison of baseline characteristics, reperfusion, functional independence, and safety outcomes with the DAWN trial intervention arm.

Main Results:

  • Twenty-one patients met inclusion criteria for extended window thrombectomy.
  • Successful reperfusion rates (mTICI2b-3) were comparable (81% vs 84%, P=0.72).
  • 90-day functional independence (mRS 0-2) and symptomatic intracranial hemorrhage rates were similar between groups.

Conclusions:

  • Thrombectomy is safe and feasible for acute ischemic stroke with LVO meeting DAWN criteria, even when treated beyond 24 hours TLKW.
  • Outcomes in this extended window group are comparable to those within the standard DAWN trial timeframe.
  • Further research is needed to confirm these findings and potentially expand treatment eligibility.