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DEFUSE 3 provided complementary randomized evidence that selected patients with anterior-circulation large-vessel occlusion can benefit from thrombectomy well beyond the traditional early treatment window. Participants presenting between six and 16 hours from last known well were selected using imaging criteria designed to identify a small infarct core with substantial potentially salvageable tissue. Thrombectomy plus standard medical treatment resulted in a marked improvement in functional outcomes compared with medical therapy alone and reduced mortality. The study is particularly important because it used physiological tissue selection rather than time alone to identify likely treatment responders. For HCPs, the clinical implication is that stroke systems need rapid access to advanced imaging and clear pathways for transfer of eligible patients. The study also reinforces the importance of avoiding therapeutic nihilism in wake-up or late-presenting stroke. At the same time, the results should be applied to patients who match the trial's vascular, clinical and imaging profile. The evidence contributes directly to IANCON's focus on advanced stroke intervention and the boundaries of endovascular treatment.
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DEFUSE 3 provided complementary randomized evidence that selected patients with anterior-circulation large-vessel occlusion can benefit from thrombectomy well beyond the traditional early treatment window. Participants presenting between six and 16 hours from last known well were selected using imaging criteria designed to identify a small infarct core with substantial potentially salvageable tissue. Thrombectomy plus standard medical treatment resulted in a marked improvement in functional outcomes compared with medical therapy alone and reduced mortality. The study is particularly important because it used physiological tissue selection rather than time alone to identify likely treatment responders. For HCPs, the clinical implication is that stroke systems need rapid access to advanced imaging and clear pathways for transfer of eligible patients. The study also reinforces the importance of avoiding therapeutic nihilism in wake-up or late-presenting stroke. At the same time, the results should be applied to patients who match the trial's vascular, clinical and imaging profile. The evidence contributes directly to IANCON's focus on advanced stroke intervention and the boundaries of endovascular treatment.
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