The efficacy of mechanical thrombectomy (MT) from 6 to 24 hours after the onset of ischemic stroke was recently established with landmark DAWN trial (DAWN). 

We retrospectively reviewed our hospital stroke registry from January 2014 to July 2018. Patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who were last seen normal 6 to 24 hours earlier, and who had a clinical to radiographic mismatch defined according to age (<80 or ≥80 years) were included. All patients were managed at a single University affiliated Community Comprehensive Stroke Center. All pre-specified DAWN criteria for inclusion and exclusion were followed. GraphPad Quick Calcs Web site was used to obtain descriptive statistics and intergroup differences.

A total of 2423 patients with ischemic strokes that were studied; 262 patients underwent endovascular interventions. Out of these 77 (29.3%) patients (males 36, Mean age 72 years), met the DAWN criteria. Early NIHSS improvement by 10 points or more as specified in the DAWN was not different (Initial median NIHSS 16, with 65% early NIHSS ≥ 4 improvement; and NIHSS ≥ 10 improvement of 32%). Similarly Recanalization rates were not significantly different with modified TICI scores of 2b/3 of 74% (n=57) when compared to 77% immediate recanalization in DAWN. Symptomatic intracranial hemorrhage did not differ significantly when compared with DAWN (6.4% (n=5) at our center and 6% in the DAWN trial, p=ns), nor did mortality (10%, n=7).

Among patients with acute stroke thrombectomy in a community setting who met the DAWN criteria in a real life setting, recanalization rates and outcomes were comparable to DAWN with similar complication rates. Multicenter registries are required to corroborate our findings.