Data Do Not Support Selection of Patients for Stroke Treatment Within the 16- to 24-Hour Interval

To the Editor The Diffusion-Weighted Imaging or Computerized Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo (DAWN) trial demonstrated benefit of endovascular treatment (EVT) in select patients 6 to 24 hours after last known well (LKW) with clinical imaging mismatch. The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE 3) trial demonstrated benefit of EVT in select patients 6 to 16 hours after LKW with target perfusion-imaging mismatch. In the article by Albers et al, the authors present independent analyses of patient-level imaging data primarily from these 2 trials for 3 time terciles: 6.0 to 9.5 hours, 9.6 to 12.7 hours, and 12.8 to 24.0 hours after LKW. Statistically significant benefits were observed in all 3 time terciles for both the clinical mismatch and target perfusion-imaging mismatch subgroups. Contrary to the authors, the 12.8- to 24-hour data cannot be interpreted as demonstrating independent validity of target perfusion-imaging mismatch criteria for selecting patients for EVT 16 to 24 hours after LKW. The positive result in the 12.8- to 16-hour tercile could solely be due to a benefit from 12.8- to 16-hour LKW (as was shown in the DEFUSE 3 trial), with neutral or negative effects in the 16- to 24-hour time period. However, even positive results for target perfusion-imaging mismatch criteria from a separate analysis of the 16- to 24-...
Source: JAMA Neurology - Category: Neurology Source Type: research