Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, October 3, 2025

DAWN Trial: Redefining the Treatment Window for Stroke Thrombectomy

 But the goal is 100% recovery! NOT JUST REPERFUSION! You completely failed business101. Here is your business101 requirements.

The latest here:

DAWN Trial: Redefining the Treatment Window for Stroke Thrombectomy

Why DAWN Changed Stroke Care

The DAWN trial (DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late-Presenting Strokes Undergoing Neurointervention with Trevo) redefined the timeline for treating ischemic stroke. By demonstrating that carefully selected patients could still benefit from thrombectomy up to 24 hours after symptom onset, DAWN shifted the paradigm of stroke systems of care(NOT RECOVERY!).

Evidence to Date

DAWN used advanced imaging, including diffusion-weighted imaging (DWI) and computed tomography perfusion (CTP), to identify patients with a mismatch between clinical deficits and infarct core size. Patients receiving thrombectomy plus standard care had dramatically higher rates of functional independence(SURVIVORS WANT 100% RECOVERY AND YOU'RE NOT EVEN TRYING FOR THAT! I'd have you all fired!) compared to those receiving standard care(NOT RECOVERY!) alone. The trial quickly influenced guidelines and broadened eligibility for endovascular therapy, makingimaging a central part of stroke triage.

Ongoing Debates and Research

Questions remain about how best to operationalize late-window thrombectomy. Not all hospitals have rapid access to perfusion imaging, and transfer delays can reduce benefit. Newer studies, such as DEFUSE 3, further confirm extended windows, but patient selection criteria continue to evolve. Additionally, efforts are underway to develop prehospital triage tools that could identify late-window candidates earlier.

Clinical Guidance for Physicians

Stroke teams should use CTP or magnetic resonance imaging (MRI) when considering thrombectomy beyond 6 hours, with DAWN criteria guiding selection. Systems of care(NOT RECOVERY!) should prioritize reducing delays from imaging to reperfusion. Even within extended windows, earlier treatment correlates with better outcomes.

Bottom Line

DAWN proved that “time is brain” extends beyond six hours—if patients are carefully selected. The trial ushered in an era where advanced imaging guides therapy, expanding opportunities for recovery while reinforcing the urgency of rapid systems-based stroke care(NOT RECOVERY!). 

Read more about the DAWN trial here

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