Dawn And Diffuse Criteria for 24 hour Stroke Window

DEFUSE 3: 6-16 hours

Ischemic core volume of <70
-Age 18-85 years
-baseline NIHSS greater than or equal to 6
Endovascular femoral puncture between 6-16 hours
Pre-stroke mRS 0-2
Anticipated life expectancy of at least 6 months

-other serious, advanced, or terminal illness
-pre-existing neurological or psychiatric disease that would confound the evaluations
-contraindication to MRI/CRP contrast
-treated with tPA >4.5 hours after LKN
-known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, oral anticoagulant with INR >3 (recent use of new oral anticoagulants ok if eGFR >30 ml/min)
-seizure at stroke onset if precludes obtaining accurate baseline NIHSS
-baseline glucose of <50 or >400
-baseline platelet count of <50, 000
-untreatable sustained hypertension SBP <185 or DBP >110
-presumed septic embolus, suspicion of bacterial endocarditis or cerebral vasculitis
-mechanical clot retrieval attempted prior to 6 hours from symptom onset

Imaging inclusion criteria:
-M1 MCA occlusion or ICA occlusion AND
-target mismatch profile on CT perfusion or MRI (RAPID)”
Ischemic core volume of <70 AND
Mismatch ration of >1.8 AND
Mismatch volume of > or equal to 15 ml
Or if only MRI, DWI lesion volume < 25 ml with M1 or CTA occlusion within 60 minutes
Neuroimaging exclusion criteria:
-ASPECTS <6 on noncontract HCT
-intracranial tumor (except for small meningioma)
-acute intracranial hemorrhage
-significant mass effect with midline shift
-evidence of ICA flow-limiting dissection or aortic dissection
-intracranial stent in the same territory that would preclude safe deployment/removal of device
-intracranial occlusions in multiple vascular territories



DAWN: 6-24 hours

Age 18 or greater
NIHSS 10 or greater
Prestroke modified rankin score <2
Anticipated life expectancy of at least 6 mo
<1/3 MCA territory involved via CT or MRI
Occlusion of either intracranial ICA and/or M1 via MRA or CTA

Clinical imaging mismatch via MRI-DWI or CTP-rCVF:
0–<21 cc core infarct; NIHSS ≥10 and age ≥80
0-<31 cc core infarct, NIHSS ≥10 and age < 80
31-<51 cc core infarct, NIHSS ≥20 and age< 80

General Exclusion criteria:
-severe head injury within 90 days
-rapid improvement to NIHSS <10 or vessel recanalization prior to randomization
-pre-existing neurological or psychiatric disease
-seizures at stroke onset
-blood glucose <50 or >400
-hemoglobin <7
-platelets <50,000
-sodium <130, potassium ❤ or >5
-renal failure
-hemorrhagic diathesis or INR >3 or PTT >3 times normal
-active or recent hemorrhage within 30 days
-severe allergy to contrast medium
-SBP >185 or diastolic BP >110
-pregnancy or lactation
-presumed septic embolus or suspicion of bacterial endocarditis
-prior treatment with thrombectomy intra-arterial therapies

Imaging exclusion criteria:
-intracranial hemorrhage
-flow limiting carotid dissection, high-grade stenosis, or complete cervical carotid occlusion
-excessive cervical vessel tortuosity
-suspected cerebral vasculitis
-suspected aortic dissection
-existing stent in the same vascular territory
-occlusions in different vascular territories
-significant mass effect/midline shift
-intracranial tumor

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