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Der Radiologe

, Volume 58, Supplement 1, pp 20–23 | Cite as

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

  • A. Ragoschke-Schumm
  • S. Walter
Review
  • 653 Downloads

Abstract

Background

Endovascular thrombectomy has been proven effective in the first 6 h after onset of stroke and large-vessel occlusion in the anterior cerebral circulation. To date, it was not clear whether thrombectomy beyond 6 h is also beneficial.

Methods

A 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.

Results

The DAWN and DEFUSE-3 trials showed the efficacy of thrombectomy in selected patients with occlusion of proximal vessels in the anterior circulation up to 24 h after suspected onset of symptoms.

Conclusion

Thrombectomy was shown to have high efficacy up to 24 h 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.

Keywords

Stroke Thrombectomy Urgent care Computed tomography Magnetic resonance imaging 

Die DAWN- und DEFUSE-3-Studie: ist Zeit immer noch wichtig?

Zusammenfassung

Hintergrund

Innerhalb der ersten 6 h nach Beginn eines Schlaganfalls wurde die Effektivität der endovaskulären Thrombektomie für proximale Gefäßverschlüsse im vorderen zerebralen Stromgebiet in mehreren Studien nachgewiesen. Es war bisher unklar, ob die Thrombektomie auch jenseits dieser Zeit von Nutzen ist.

Methode

Die kürzlich präsentierten Daten der prospektiven DAWN- (DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo) und der DEFUSE-3-Studie (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) , die den Nutzen der Thrombektomie bei selektierten Patienten mit Verschlüssen proximaler anteriorer Hirngefäße bis zu 24 h nach mutmaßlichem Beginn der Symptomatik zeigten, werden zusammengefasst.

Schlussfolgerung

Bei einer selektierten Gruppe von Patienten wurde die Effizienz einer endovaskulären Thrombektomie bis zu 24 h nach mutmaßlichem Symptombeginn gezeigt. Allerdings ist die Indikationsstellung komplex. Weiterhin gilt, dass bei Patienten mit schwerem Schlaganfall sehr frühzeitig eine intrakranielle Gefäßdarstellung erfolgen muss, damit eine rasche Diagnostik und Therapie ohne Verzögerung durchgeführt werden kann. Die Kooperation existierender neurovaskulärer Netzwerke muss an die Ergebnisse dieser beiden Studien angepasst werden.

Schlüsselwörter

Schlaganfall Thrombektomie Akutbehandlung Computertomographie Magnetresonanztomographie 

Notes

Compliance with ethical guidelines

Conflict of interest

A. Ragoschke-Schumm and S. Walter declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

The supplement containing this article is not sponsored by industry.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologySaarland UniversityHomburgGermany

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