6/28/23, 1:15 AM DAWN Pathway Feedback Search Clinical Topics Home Studies DAWN DAWN Disease Disease Acute ischemic stroke Carotid artery stenosis Trial question What is the role of thrombectomy among patients with acute stroke who had last been known to be well 6 to 24 hours earlier and who had a mismatch between clinical deficit and infarct? Study design Multi-center Open label RCT Population Characteristics of study participants 55.0% female N = 206 45.0% male 206 patients (113 female, 93 male) Inclusion criteria: patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who had last been known to be well 6 to 24 hours earlier and who had a mismatch between the severity of the clinical deficit and the infarct volume Key exclusion criteria: history of severe head injury within past 90 days with residual neurological deficit, pre-existing neurological or psychiatric disease that would confound the neurological or functional evaluations, known hemorrhagic diathesis, coagulation factor deficiency, severe sustained hypertension Interventions N=107 thrombectomy (thrombectomy with the use of the Trevo device plus standard medical care) https://web.pathway.md/studies/recAT7BnPyZqA3BTg 1/2 6/28/23, 1:15 AM DAWN Pathway N=99 control (standard medical care alone) Primary outcome Score on utility-weighted modified Rankin scale at 90 days 5.5 5.5 4.1 3.4 2.8 1.4 Significant increase 0.0 Thrombectomy Control Significant increase in score on utility-weighted mRS at 90 days (5.5 vs. 3.4; AD 2, 95% CI 1.1 to 3) Secondary outcomes Significant increase in functional independence at 90 days (49% vs. 13%; AD 33%, 95% CI 21 to 44) Significant increase in early response (48% vs. 19%; RR 3, 95% CI 2 to 4) Significant increase in recanalization at 24 hours (77% vs. 39%; RR 2, 95% CI 2 to 4) Safety outcomes No significant differences in symptomatic intracranial hemorrhage, death from any cause or stroke-related death at 90 days. Significant difference in neurological deterioration (14% vs. 26%). Conclusion In patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who had last been known to be well 6 to 24 hours earlier and who had a mismatch between the severity of the clinical deficit and the infarct volume, thrombectomy was superior to control with respect to score on utility-weighted mRS at 90 days. Reference Raul G Nogueira, Ashutosh P Jadhav, Diogo C Haussen et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018 Jan 4;378(1):11-21. Open reference URL https://web.pathway.md/studies/recAT7BnPyZqA3BTg 2/2