Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis
Abstract The role of intravenous thrombolysis (IVT) in combination with endovascular thrombectomy (EVT) for the treatment of large vessel occlusion acute ischemic stroke has been evaluated exclusively outside the US, in randomized clinical trials which failed to demonstrate non-inferiority of skippi...
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Nature Portfolio
2025-05-01
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| author | Youngran Kim Sergio Salazar-Marioni Rania Abdelkhaleq Ananya Iyyangar Diogo Haussen Jonathan Grossberg Jaydevsinh Dolia Aqueel Pabaney Mahmoud Mohammaden Ameer Hassan Wondwossen Tekle Hamzah Saei Mohamad Abdalkader Piers Klein Taha Nisar Adeel Saleemi Shahram Majidi Johanna Fifi Gabrielle Valestin Guillermo Linares Kara Christopher David S Liebeskind Mouhammad Jumaa Syed Zaidi Raul Nogueira Brijesh Mehta Joy Sessa Juan Vivanco-Suarez Aaron Rodriguez-Calienes Milagros Galecio-Castillo Santiago Ortega-Gutierrez James Siegler Mary Penckofer Italo Linfante Sunil A Sheth for the SVIN Registry Consortium |
| author_facet | Youngran Kim Sergio Salazar-Marioni Rania Abdelkhaleq Ananya Iyyangar Diogo Haussen Jonathan Grossberg Jaydevsinh Dolia Aqueel Pabaney Mahmoud Mohammaden Ameer Hassan Wondwossen Tekle Hamzah Saei Mohamad Abdalkader Piers Klein Taha Nisar Adeel Saleemi Shahram Majidi Johanna Fifi Gabrielle Valestin Guillermo Linares Kara Christopher David S Liebeskind Mouhammad Jumaa Syed Zaidi Raul Nogueira Brijesh Mehta Joy Sessa Juan Vivanco-Suarez Aaron Rodriguez-Calienes Milagros Galecio-Castillo Santiago Ortega-Gutierrez James Siegler Mary Penckofer Italo Linfante Sunil A Sheth for the SVIN Registry Consortium |
| author_sort | Youngran Kim |
| collection | DOAJ |
| description | Abstract The role of intravenous thrombolysis (IVT) in combination with endovascular thrombectomy (EVT) for the treatment of large vessel occlusion acute ischemic stroke has been evaluated exclusively outside the US, in randomized clinical trials which failed to demonstrate non-inferiority of skipping IVT. Because practice patterns and IVT dosing differ within the US, and prior observational US-based cohorts suggested improved clinical outcomes in patients who received IVT before EVT, a US-based evaluation is needed. This is a quasi-experimental study of a large US cohort using a regression discontinuity design (RDD) that enables the estimation of causal effects when randomization is not feasible. In this multi-center prospective cohort of patients undergoing EVT, we observed a sharp drop (65%) in the probability of receiving IVT at the cutoff of IVT eligibility time window while there were no significant differences in potential confounders including age, NIHSS, and ASPECTS at the cutoff. We found no association between IVT treatment and functional independence (mRS 0–2) at 90-days in patients undergoing EVT, nor in the secondary outcomes of excellent outcomes (mRS 0–1) at 90 days, mortality, symptomatic intracranial hemorrhage, first pass reperfusion, or final reperfusion. |
| format | Article |
| id | doaj-art-5fa27a7e5bae44b1b37f998330eee7fd |
| institution | OA Journals |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Nature Portfolio |
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| spelling | doaj-art-5fa27a7e5bae44b1b37f998330eee7fd2025-08-20T02:03:35ZengNature PortfolioScientific Reports2045-23222025-05-011511910.1038/s41598-025-03249-4Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysisYoungran Kim0Sergio Salazar-Marioni1Rania Abdelkhaleq2Ananya Iyyangar3Diogo Haussen4Jonathan Grossberg5Jaydevsinh Dolia6Aqueel Pabaney7Mahmoud Mohammaden8Ameer Hassan9Wondwossen Tekle10Hamzah Saei11Mohamad Abdalkader12Piers Klein13Taha Nisar14Adeel Saleemi15Shahram Majidi16Johanna Fifi17Gabrielle Valestin18Guillermo Linares19Kara Christopher20David S Liebeskind21Mouhammad Jumaa22Syed Zaidi23Raul Nogueira24Brijesh Mehta25Joy Sessa26Juan Vivanco-Suarez27Aaron Rodriguez-Calienes28Milagros Galecio-Castillo29Santiago Ortega-Gutierrez30James Siegler31Mary Penckofer32Italo Linfante33Sunil A Sheth34for the SVIN Registry ConsortiumDepartment of Management, Policy, and Community Health, UTHealth School of Public HealthDepartment of Neurology, UTHealth McGovern Medical SchoolDepartment of Neurology, UTHealth McGovern Medical SchoolDepartment of Neurology, UTHealth McGovern Medical SchoolEmory School of Medicine/Grady Memorial HospitalEmory School of Medicine/Grady Memorial HospitalEmory School of Medicine/Grady Memorial HospitalEmory School of Medicine/Grady Memorial HospitalEmory School of Medicine/Grady Memorial HospitalDepartment of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical CenterDepartment of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical CenterDepartment of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical CenterBoston Medical Center, Boston University Chobanian and Avedisian School of MedicineBoston Medical Center, Boston University Chobanian and Avedisian School of MedicineDepartment of Neurology, University of South AlabamaDepartment of Neurology, University of South AlabamaDepartment of Neurosurgery, Icahn School of Medicine at Mount SinaiDepartment of Neurosurgery, Icahn School of Medicine at Mount SinaiDepartment of Neurosurgery, Icahn School of Medicine at Mount SinaiDepartment of Neurology, Saint Louis UniversityDepartment of Neurology, Saint Louis UniversityDepartment of Neurology, University of California Los AngelesProMedica Toledo Hospital, University of ToledoProMedica Toledo Hospital, University of ToledoDepartment of Neurology, University of PittsburgMemorial Neuroscience InstituteMemorial Neuroscience InstituteDepartment of Neurology, Neurosurgery and Radiology, University of IowaDepartment of Neurology, Neurosurgery and Radiology, University of IowaDepartment of Neurology, Neurosurgery and Radiology, University of IowaDepartment of Neurology, Neurosurgery and Radiology, University of IowaCooper Medical School, Rowan UniversityCooper Medical School, Rowan UniversityMiami Cardiac and Vascular InstituteDepartment of Neurology, UTHealth McGovern Medical SchoolAbstract The role of intravenous thrombolysis (IVT) in combination with endovascular thrombectomy (EVT) for the treatment of large vessel occlusion acute ischemic stroke has been evaluated exclusively outside the US, in randomized clinical trials which failed to demonstrate non-inferiority of skipping IVT. Because practice patterns and IVT dosing differ within the US, and prior observational US-based cohorts suggested improved clinical outcomes in patients who received IVT before EVT, a US-based evaluation is needed. This is a quasi-experimental study of a large US cohort using a regression discontinuity design (RDD) that enables the estimation of causal effects when randomization is not feasible. In this multi-center prospective cohort of patients undergoing EVT, we observed a sharp drop (65%) in the probability of receiving IVT at the cutoff of IVT eligibility time window while there were no significant differences in potential confounders including age, NIHSS, and ASPECTS at the cutoff. We found no association between IVT treatment and functional independence (mRS 0–2) at 90-days in patients undergoing EVT, nor in the secondary outcomes of excellent outcomes (mRS 0–1) at 90 days, mortality, symptomatic intracranial hemorrhage, first pass reperfusion, or final reperfusion.https://doi.org/10.1038/s41598-025-03249-4 |
| spellingShingle | Youngran Kim Sergio Salazar-Marioni Rania Abdelkhaleq Ananya Iyyangar Diogo Haussen Jonathan Grossberg Jaydevsinh Dolia Aqueel Pabaney Mahmoud Mohammaden Ameer Hassan Wondwossen Tekle Hamzah Saei Mohamad Abdalkader Piers Klein Taha Nisar Adeel Saleemi Shahram Majidi Johanna Fifi Gabrielle Valestin Guillermo Linares Kara Christopher David S Liebeskind Mouhammad Jumaa Syed Zaidi Raul Nogueira Brijesh Mehta Joy Sessa Juan Vivanco-Suarez Aaron Rodriguez-Calienes Milagros Galecio-Castillo Santiago Ortega-Gutierrez James Siegler Mary Penckofer Italo Linfante Sunil A Sheth for the SVIN Registry Consortium Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis Scientific Reports |
| title | Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis |
| title_full | Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis |
| title_fullStr | Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis |
| title_full_unstemmed | Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis |
| title_short | Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis |
| title_sort | comparison of thrombectomy alone versus bridging thrombolysis in a us population using regression discontinuity analysis |
| url | https://doi.org/10.1038/s41598-025-03249-4 |
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