6/28/23, 1:15 AM DEFUSE 3 Pathway Feedback Search Clinical Topics Home Studies DEFUSE 3 DEFUSE 3 Disease Disease Disease Acute ischemic stroke Carotid artery stenosis Transient Trial question What is the role of endovascular thrombectomy among patients with proximal middle cerebral artery or internal carotid artery occlusion and a region of tissue that was ischemic but not yet infarcted? Study design Multi-center Open label RCT Population Characteristics of study participants 51.0% female N = 182 49.0% male 182 patients (92 female, 90 male) Inclusion criteria: patients 6 to 16 hours after they were last known to be well and who had remaining ischemic brain tissue that was not yet infarcted Key exclusion criteria: terminal illness, current anticoagulant use, history of diabetes or prior stroke, known hereditary or acquired hemorrhagic diathesis, severe sustained hypertension, presumed septic embolus, suspicion of bacterial endocarditis Interventions N=92 endovascular therapy (thrombectomy plus standard medical therapy) N=90 medical therapy (standard medical therapy alone) https://web.pathway.md/studies/rec8xTlbcO8elTKo0 1/2 6/28/23, 1:15 AM DEFUSE 3 Pathway Primary outcome Median score on modified Rankin scale at 90 days 4.0 4 3.0 3 2.0 1.0 Significant increase 0.0 Endovascular therapy Medical therapy Significant increase in median score on mRS at 90 days (3 vs. 4; OR 2.77, 95% CI 1.63 to 4.7) Secondary outcomes Significant increase in functional independence at 90 days (45% vs. 17%; RR 2.67, 95% CI 1.6 to 4.48) No significant difference in death at 90 days (14% vs. 26%; RR 0.55, 95% CI 0.3 to 1.02) Significant increase in complete recanalization at 24 hours (78% vs. 18%; RR 4.31, 95% CI 2.65 to 7.01) Safety outcomes No significant differences in serious adverse events, symptomatic intracranial hemorrhage, early neurologic deterioration, parenchymal hematoma type 2. Significant difference in reperfusion > 90% at 24 hours (79% vs. 18%). Conclusion In patients 6 to 16 hours after they were last known to be well and who had remaining ischemic brain tissue that was not yet infarcted, endovascular therapy was superior to medical therapy with respect to median score on mRS at 90 days. Reference Gregory W Albers, Michael P Marks, Stephanie Kemp et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018 Feb 22;378(8):708-718. Open reference URL https://web.pathway.md/studies/rec8xTlbcO8elTKo0 2/2