Mechanical thrombectomy for large vessel occlusion between 6 and 24 h: outcome comparison of DEFUSE-3/DAWN eligible versus non-eligible patients

Tolga D Dittrich¹, Peter B Sporns^{2

3}, Lilian F Kriemler^{1

4}, Salome Rudin¹, Anh Nguyen², Annaelle Zietz¹, Alexandros A Polymeris¹, Christopher Tränka¹, Sebastian Thilemann¹, Benjamin Wagner¹, Valerian L Altersberger¹, Ines Piot¹, Filip Barinka⁵, Martin Hänsel⁶, Henrik Gensicke^{1

7}, Stefan T Engelter^{1

7}, Philippe A Lyrer¹, Raoul Sutter⁸, Christian H Nickel⁹, Mira Katan^{1

6}, Nils Peters^{1

5}, Lars Michels^{10

11}, Zsolt Kulcsár¹⁰, Grzegorz M Karwacki¹², Marco Pileggi¹³, Carlo Cereda¹⁴, Susanne Wegener⁶, Leo H Bonati^{1

15}, Urs Fischer¹, Marios Psychogios², Gian Marco De Marchis¹

Affiliations

¹ Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
² Department of Neuroradiology, University Hospital Basel, Basel, Switzerland.
³ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴ Clinic for Internal Medicine, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland.
⁵ Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland.
⁶ Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
⁷ Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland.
⁸ Department of Intensive Care Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
⁹ Emergency Department, University Hospital Basel and University of Basel, Basel, Switzerland.
¹⁰ Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
¹¹ Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland.
¹² Department of Radiology and Nuclear Medicine, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
¹³ Department of Neuroradiology, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland.
¹⁴ Department of Neurology and Stroke Center, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland.
¹⁵ Rheinfelden Rehabilitation Clinic, Rheinfelden, Switzerland.

PMID: 36367319
DOI: 10.1177/17474930221140793

Mechanical thrombectomy for large vessel occlusion between 6 and 24 h: outcome comparison of DEFUSE-3/DAWN eligible versus non-eligible patients

Tolga D Dittrich et al. Int J Stroke. 2023 Jul.

. 2023 Jul;18(6):697-703.

doi: 10.1177/17474930221140793. Epub 2022 Dec 14.

Authors

Affiliations

¹ Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
² Department of Neuroradiology, University Hospital Basel, Basel, Switzerland.
³ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴ Clinic for Internal Medicine, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland.
⁵ Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland.
⁶ Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
⁷ Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland.
⁸ Department of Intensive Care Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
⁹ Emergency Department, University Hospital Basel and University of Basel, Basel, Switzerland.
¹⁰ Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
¹¹ Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland.
¹² Department of Radiology and Nuclear Medicine, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
¹³ Department of Neuroradiology, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland.
¹⁴ Department of Neurology and Stroke Center, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland.
¹⁵ Rheinfelden Rehabilitation Clinic, Rheinfelden, Switzerland.

PMID: 36367319
DOI: 10.1177/17474930221140793

Abstract

Background: The DEFUSE-3 and DAWN trials showed that mechanical thrombectomy (MT) improves the outcome of selected patients with anterior circulation large vessel occlusions (LVO) up to 24 h after stroke onset. However, it is unknown whether only those patients fulfilling the trial inclusion criteria benefit, or whether benefit is seen in a broader range of patients presenting between 6 and 24 h.

Aims: We determined whether fulfilling the DEFUSE-3 and DAWN selection criteria affects outcomes in MT patients in clinical practice.

Methods: We reviewed adult patients with LVO treated with MT between 6 and 24 h after stroke onset at five Swiss stroke centers between 2014 and 2021. We compared two groups: (1) patients who satisfied neither DEFUSE-3 nor DAWN criteria (NDND) and (2) those who satisfied DEFUSE-3 or DAWN criteria (DOD). We used logistic regression to examine the impact of trial eligibility on two safety outcomes (symptomatic intracranial hemorrhage [sICH] and all-cause mortality at 3 months) and two efficacy outcomes (modified Rankin Score [mRS] shift toward lower categories and mRS of 0-2 at 3 months).

Results: Of 174 patients who received MT, 102 (59%) belonged to the NDND group. Rates of sICH were similar between the NDND group and the DOD group (3% vs. 4%, p = 1.00). Multivariable regression revealed no differences in 3-month all-cause mortality (aOR 2.07, 95% CI 0.64-6.84, p = 0.23) or functional outcomes (mRS shift: acOR 0.81, 95% CI 0.37-1.79, p = 0.60; mRS 0-2: aOR 0.91, 95% CI 0.31-2.57, p = 0.85).

Conclusion: Among adult patients with LVO treated with MT between 6 and 24 h, safety and efficacy outcomes were similar between DEFUSE-3/DAWN eligible and ineligible patients. Our data provide a compelling rationale for randomized trials with broader inclusion criteria for MT.

Keywords: Ischemic stroke; endovascular treatment; large vessel occlusion.

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Mechanical thrombectomy for large vessel occlusion between 6 and 24 h: outcome comparison of DEFUSE-3/DAWN eligible versus non-eligible patients

Affiliations

Mechanical thrombectomy for large vessel occlusion between 6 and 24 h: outcome comparison of DEFUSE-3/DAWN eligible versus non-eligible patients

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Abstract

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Medical