How do DAWN and DEFUSE-3 criteria differ for extending the thrombectomy window?

How do DAWN and DEFUSE-3 criteria differ for extending the thrombectomy window?

• A. DAWN uses clinical-core mismatch within 6–24 hours; DEFUSE-3 uses perfusion mismatch within 6–16/24 hours with imaging criteria.
• B. DAWN uses perfusion mismatch; DEFUSE-3 uses clinical-core mismatch.
• C. Both use the same criteria.
• D. DAWN window is 0-6 hours; DEFUSE-3 window is 6-24 hours.

Answer: (C)

The key idea is that these trials use different ways to identify tissue that can still be saved and, as a result, extend the treatment window in different ways. In DAWN, eligibility is based on a clinical deficit that is out of proportion to the apparent infarct core — a clinical-core mismatch. This means you look at how severe the neurological symptoms are compared with how large the infarct looks on imaging, and if they don’t match up, you may still treat up to 24 hours after onset. In DEFUSE-3, eligibility relies on perfusion imaging to show a perfusion (penumbral) mismatch — there’s a substantial amount of salvageable tissue relative to the core infarct. This approach extends treatment to about 16 hours after onset. So they’re not the same criteria. DAWN uses clinical-core mismatch and allows a longer window up to 24 hours, while DEFUSE-3 uses perfusion mismatch and extends the window to about 16 hours.

The key idea is that these trials use different ways to identify tissue that can still be saved and, as a result, extend the treatment window in different ways. In DAWN, eligibility is based on a clinical deficit that is out of proportion to the apparent infarct core — a clinical-core mismatch. This means you look at how severe the neurological symptoms are compared with how large the infarct looks on imaging, and if they don’t match up, you may still treat up to 24 hours after onset.

In DEFUSE-3, eligibility relies on perfusion imaging to show a perfusion (penumbral) mismatch — there’s a substantial amount of salvageable tissue relative to the core infarct. This approach extends treatment to about 16 hours after onset.

So they’re not the same criteria. DAWN uses clinical-core mismatch and allows a longer window up to 24 hours, while DEFUSE-3 uses perfusion mismatch and extends the window to about 16 hours.