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DAWN Trial - Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct

This is a prospective randomized controlled trial comparing best medical therapy vs. thrombectomy plus best medical therapy for patients who presented with acute stroke to thrombectomy capable centers with a last known well of 6 to 24 hours earlier. Patients were screened using automated software to determine the volume of core infarction at presentation by MRI or CT-Perfusion.  Patients with a mismatch between clinical deficit and stroke volume permissible by the inclusion criteria were randomized to best medical therapy vs. thrombectomy plus best medical therapy.  206 patients in total were enrolled; 107 assigned to the thrombectomy group and 99 to the control group.  Per the study protocol there was no rescue therapy and only angioplasty of tandem cervical carotid disease was permissible.  102 of the 105 patients who received intervention, had intervention with the Trevo strenttriever device only.  Among patients who underwent thrombectomy, the recanalization rate was 84%.  The rate of functional independence in the thrombectomy group was 49% versus only 13% in the control group. NNT of 2 for improved disability at 90 days.  NNT of 2.8 for functional independence at 90 days.  The rates of death and symptomatic hemorrhage were comparable in both arms of the study. 

10.1056/NEJMoa1706442

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American Association of Neurological Surgeons

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