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The DAWN trial changed the concept of the treatment window for mechanical thrombectomy in acute ischemic stroke. It enrolled selected patients with anterior-circulation large-vessel occlusion who presented between six and 24 hours after they were last known well and who had a clinical-core mismatch indicating potentially salvageable brain tissue. Patients assigned to thrombectomy plus standard medical therapy had substantially better functional outcomes than those receiving medical therapy alone. The trial demonstrated that time since symptom onset should not be interpreted in isolation when advanced imaging can identify patients with a favourable tissue profile. For HCPs, the practical message is to think in terms of physiology as well as chronology. Wake-up strokes and late-presenting patients may still benefit from thrombectomy when they satisfy appropriate clinical and imaging criteria. Rapid access to vascular imaging and transfer pathways therefore becomes part of the treatment itself. DAWN does not support indiscriminate thrombectomy beyond 6 hours; its lesson is that carefully selected patients can have substantial benefit even when the conventional time window has passed.
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The DAWN trial changed the concept of the treatment window for mechanical thrombectomy in acute ischemic stroke. It enrolled selected patients with anterior-circulation large-vessel occlusion who presented between six and 24 hours after they were last known well and who had a clinical-core mismatch indicating potentially salvageable brain tissue. Patients assigned to thrombectomy plus standard medical therapy had substantially better functional outcomes than those receiving medical therapy alone. The trial demonstrated that time since symptom onset should not be interpreted in isolation when advanced imaging can identify patients with a favourable tissue profile. For HCPs, the practical message is to think in terms of physiology as well as chronology. Wake-up strokes and late-presenting patients may still benefit from thrombectomy when they satisfy appropriate clinical and imaging criteria. Rapid access to vascular imaging and transfer pathways therefore becomes part of the treatment itself. DAWN does not support indiscriminate thrombectomy beyond 6 hours; its lesson is that carefully selected patients can have substantial benefit even when the conventional time window has passed.
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