DAWN and DEFUSE-3 trials: is time still important?

BackgroundEndovascular thrombectomy has been proven effective in the first 6h after onset of stroke and large-vessel occlusion in the anterior cerebral circulation. To date, it was not clear whether thrombectomy beyond 6h is also beneficial.MethodsA summary of the prospective DAWN (DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo) and DEFUSE-3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) trials is presented.ResultsThe DAWN and DEFUSE-3 trials showed the efficacy of thrombectomy in selected patients with occlusion of proximal vessels in the anterior circulation up to 24h after suspected onset of symptoms.ConclusionThrombectomy was shown to have high efficacy up to 24h after suspected symptom onset; however, patient selection is very complex. Early detection of large-vessel occlusion is of utmost importance. The cooperation between existing neurovascular networks should be adapted according to these new findings.