Author Interview: Drs. Thabele (Bay) Leslie-Mazwi, MD, and Gregory W. Albers, MD, on “DEFUSE 3 Non-DAWN Patients: A Closer Look at Late Window Thrombectomy Selection”
An interview with Dr. Thabele (Bay) Leslie-Mazwi, MD, Director of Endovascular Stroke Services, Massachusetts General Hospital; Assistant Professor of Neurology, Harvard University; and Dr. Gregory W. Albers, MD, Director, Stanford Stroke Center; Professor of Neurology, Stanford University.
Interviewed by Kristina Shkirkova, BSc, Doctoral Student in Neuroscience, Department of Neurosurgery, Zilkha Neurogenetic Institute, University of Southern California.
They will be discussing the article “DEFUSE 3 Non-DAWN Patients: A Closer Look at Late Window Thrombectomy Selection,” published in the March 2019 issue of Stroke.
Ms. Shkirkova: Please briefly summarize the design and findings of your study.
Drs. Leslie-Mazwi and Albers: We evaluated DEFUSE 3 patients who would have been excluded from the DAWN trial based on DAWN eligibility criteria, with the goal of assessing treatment effect in that DEFUSE 3 subgroup (DEFUSE 3 Non-DAWN). The main reasons for DEFUSE 3 Non-DAWN were NIHSS 6-9, core too large (based on age and volume of established infarct), and mRS of 2. Patients with mRS 2 were included with the NIH stroke scale 6-9 group, as detailed in our paper, and so we analyzed the DEFUSE 3 Non-DAWN patients NIHSS 6-9 and core-too-large patients to assess treatment effect in that subgroup.
Patients with pretreatment core infarct volumes <70ml but too large for inclusion by DAWN criteria demonstrated robust benefit from endovascular therapy. Data supporting a beneficial treatment effect across the full range of NIHSS scores was documented in the entire DEFUSE 3 population. In our small subgroup of patients with NIHSS 6-9, we found a trend towards benefit.