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Updated: Aug 24, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Comparison between collateral status and DEFUSE 3 or DAWN criteria in patient selection for endovascular thrombectomy
Yuling Shen1, Mao Li1, Yun Chen1
1Department of Neurology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Insights
This meta-analysis compares collateral blood flow criteria with DEFUSE 3 or DAWN criteria for selecting stroke patients for endovascular therapy (EVT). It aims to determine if collateral status is as effective as established imaging criteria for extended window EVT eligibility.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Endovascular therapy (EVT) selection for large vessel occlusion stroke often relies on DEFUSE 3 or DAWN perfusion imaging criteria.
- Emerging evidence suggests collateral blood flow assessment may offer comparable efficacy for EVT eligibility in extended time windows.
Purpose of the Study:
- To conduct a meta-analysis comparing collateral status-based imaging criteria with DEFUSE 3 or DAWN criteria.
- To evaluate the effectiveness of collateral blood flow assessment in selecting patients for extended window EVT.
Main Methods:
- Systematic literature search of PubMed, EMBASE, Web of Science, and Cochrane Library (Nov 2017-Nov 2021).
- Independent study screening and data extraction by two investigators.
- Quality assessment using Newcastle-Ottawa Scale or Cochrane risk bias tool; data analysis with Stata V.17.
Main Results:
- The meta-analysis will synthesize data from eligible studies comparing collateral status and DEFUSE 3/DAWN criteria.
- Statistical analysis will determine the comparative effectiveness of these imaging approaches.
Conclusions:
- Findings will inform optimal imaging selection criteria for endovascular therapy in acute ischemic stroke.
- This research may refine patient selection for extended window treatment, potentially improving outcomes.
Introduction:
Perfusion imaging according to the DEFUSE 3 or DAWN criteria has been applied to select patients with large vascular occlusive stroke undergo endovascular therapy (EVT) in the extended time window. Emerging studies have shown that collateral blood flow-based criteria may be as effective as DEFUSE 3 and DAWN criteria for the evaluation of EVT eligibility beyond 6 hours. We will conduct a meta-analysis to compare collateral status-based criteria with DEFUSE 3 or DAWN criteria.
Methods And Analysis:
We will conduct a search for the studies comparing collateral blood flow-based imaging with CT perfusion using the DEFUSE 3 or DAWN criteria in selecting patients with acute ischaemic stroke undergo EVT in the Web of Science, PubMed, EMBASE and the Cochrane Library databases between November 2017 and November 2021. We will also search the sources of grey literature, the reference lists of included studies and the newly published studies during the review period. Two investigators will independently screen the eligible studies and extract data. The study quality will be assessed by using the Newcastle-Ottawa Scale or the Cochrane risk bias tool. Stata V.17 will be used to conduct data analysis.
Ethics And Dissemination:
Patient informed consent and ethics approval are not necessary as this study uses only published studies. The finding of this meta-analysis will be propagated through committee conferences or peer-reviewed journals.
Prospero Registration Number:
CRD42021281928.
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