Scientific Reports (May 2025)
Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis
- 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
Affiliations
- Youngran Kim
- Department of Management, Policy, and Community Health, UTHealth School of Public Health
- Sergio Salazar-Marioni
- Department of Neurology, UTHealth McGovern Medical School
- Rania Abdelkhaleq
- Department of Neurology, UTHealth McGovern Medical School
- Ananya Iyyangar
- Department of Neurology, UTHealth McGovern Medical School
- Diogo Haussen
- Emory School of Medicine/Grady Memorial Hospital
- Jonathan Grossberg
- Emory School of Medicine/Grady Memorial Hospital
- Jaydevsinh Dolia
- Emory School of Medicine/Grady Memorial Hospital
- Aqueel Pabaney
- Emory School of Medicine/Grady Memorial Hospital
- Mahmoud Mohammaden
- Emory School of Medicine/Grady Memorial Hospital
- Ameer Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center
- Wondwossen Tekle
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center
- Hamzah Saei
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center
- Mohamad Abdalkader
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine
- Piers Klein
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine
- Taha Nisar
- Department of Neurology, University of South Alabama
- Adeel Saleemi
- Department of Neurology, University of South Alabama
- Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
- Johanna Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
- Gabrielle Valestin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
- Guillermo Linares
- Department of Neurology, Saint Louis University
- Kara Christopher
- Department of Neurology, Saint Louis University
- David S Liebeskind
- Department of Neurology, University of California Los Angeles
- Mouhammad Jumaa
- ProMedica Toledo Hospital, University of Toledo
- Syed Zaidi
- ProMedica Toledo Hospital, University of Toledo
- Raul Nogueira
- Department of Neurology, University of Pittsburg
- Brijesh Mehta
- Memorial Neuroscience Institute
- Joy Sessa
- Memorial Neuroscience Institute
- Juan Vivanco-Suarez
- Department of Neurology, Neurosurgery and Radiology, University of Iowa
- Aaron Rodriguez-Calienes
- Department of Neurology, Neurosurgery and Radiology, University of Iowa
- Milagros Galecio-Castillo
- Department of Neurology, Neurosurgery and Radiology, University of Iowa
- Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery and Radiology, University of Iowa
- James Siegler
- Cooper Medical School, Rowan University
- Mary Penckofer
- Cooper Medical School, Rowan University
- Italo Linfante
- Miami Cardiac and Vascular Institute
- Sunil A Sheth
- Department of Neurology, UTHealth McGovern Medical School
- for the SVIN Registry Consortium
- DOI
- https://doi.org/10.1038/s41598-025-03249-4
- Journal volume & issue
-
Vol. 15,
no. 1
pp. 1 – 9
Abstract
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.
