The document summarizes the inclusion criteria for two clinical trials: DAWN and DEFUSE 3. Both trials evaluated endovascular thrombectomy for acute ischemic stroke between 6-24 hours after onset. The general criteria for both trials were: age 18 or older, NIHSS score of 10 or higher, signs of acute ischemic stroke, and ability to receive treatment within 6-24 hours. The imaging criteria for both trials required an occlusion of the intracranial ICA or MCA and a clinical-imaging mismatch between the ischemic core and hypoperfused tissue on MRI/CT perfusion. DEFUSE 3 specifically required a core of less than 70ml, mismatch ratio of 1.8 or higher, and mismatch volume of 15

1. DAWN and
DEFUSE 3
trial

2. Diffusion-weighted imaging or
computerized tomography
perfusion assessment with clinical
mismatch in the triage of wake up
and late presenting strokes
undergoing neurointervention with
Trevo (DAWN) trial methods
Int J Stroke.
2017 Aug;12(6):641-652. 2017, Vol. 12(6)
641–652

3. General inclusion criteria
1. Clinical signs and symptoms consistent with the diagnosis of an
acute ischemic stroke, and subject belongs to one of the following
subgroups:
a. Subject has failed IV t-PA therapy (defined as a confirmed
persistent occlusion 60 min after administration)
b. Subject is contraindicated for IV t-PA administration
2. Age ≥18
3. Baseline NIHSS ≥10
4. Subject can be randomized between with 6 to 24 h after time last
known well
5. No significant pre-stroke disability (pre-stroke mRS must be 0 or 1)
6. Anticipated life expectancy of at least 6 months
7. Subject willing/able to return for protocol required follow-up visits
8. Subject or subject’s legally authorized representative (LAR) has
signed the study informed consent form

4. Imaging inclusion
criteria
1. <1/3 MCA territory involved, as evidenced by
CT or MRI
2. Occlusion of the intracranial ICA and/or MCA-
M1 as evidenced by MRA or CTA
3. Clinical imaging mismatch (CIM) defined as
one of the following on MR-DWI or CTP-rCBF
maps:
a. ≥ 80 y/o, NIHSS ≥10 + core <21 mL
b. < 80 y/o, NIHSS ≥10 + core <31 mL
c. < 80 y/o, NIHSS ≥20 + core <51 mL

6. Thrombectomy 6 to 24 Hours
after Stroke with a Mismatch
between Deficit and Infarct
N Engl J Med.
2018 Jan 4;378(1):11-21.

10. A multicenter randomized
controlled trial of endovascular
therapy following imaging
evaluation for ischemic stroke
(DEFUSE 3)
Int J Stroke.
2017 Oct;12(8):896-905.

11. Clinical inclusion criteria
1. Signs and symptoms consistent with the diagnosis of
an acute anterior circulation ischemic stroke
2. Age 18–90 years
3. Baseline NIHSS score ≥6
4. Endovascular treatment can be initiated (femoral
puncture) between 6 and 16 h of stroke onset. Stroke
onset is defined as the time the patient was last known
to be at their neurologic baseline (wake-up strokes are
eligible if they meet the above time limits)
5. Modified Rankin Scale ≤2 prior to qualifying stroke
6. Patient/Legally authorized representative has signed
the informed consent form

12. Neuroimaging inclusion
criteria
1. ICA or MCA-M1 occlusion (carotid occlusions
can be cervical or intracranial; with or without
tandem MCA lesions) by MRA or CTA
2. Target Mismatch Profile on CT perfusion or
MRI (ischemic core volume is <70 ml,
mismatch ratio is ≥1.8 and mismatch volume is
≥15 ml)

13. RAPID mismatch map.
The RAPID mismatch summary map allows investigators to
quickly, accurately, and easily determine if the patient meets the
imaging criteria for enrollment.
The case shown here meets the Target Mismatch criteria: core
volume is<70 ml, mismatch ratio is ≥1.8 and mismatch volume
is ≥15 ml.

14. Thrombectomy for Stroke at 6
to 16 Hours with Selection by
Perfusion Imaging
N Engl J Med.
2018 Feb 22;378(8):708-718.

15. A baseline CT perfusion scan that was obtained with the
use of RAPID software shows a region of severely
reduced cerebral blood flow (<30% of that in normal
tissue), which represents the early infarct (ischemic
core), of 23 ml (pink) and a region of perfusion delay of
more than 6 seconds, which represents hypoperfused
tissue, of 128 ml (green).
Volume of Ischemic Core, 23 ml Volume of Perfusion Lesion, 128 ml
Mismatch volume, 105 ml
Mismatch ratio, 5.6