Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis

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.

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Publication Details

Journal
Scientific Reports
Published
2025-05-28
DOI
https://doi.org/10.1038/s41598-025-03249-4
Citations
3
Primary Topic
Acute Ischemic Stroke Management
Type
article
Field-Weighted Citation Impact
4.06

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article

Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis

Sunil A. Sheth, Hamzah Saei, Mahmoud H. Mohammaden, Jonathan Andrew Grossberg et al.
3 citations
Scientific Reports
Acute Ischemic Stroke Management
4.06
article

Comparison of thrombectomy alone versus bridging thrombolysis in a US population using regression discontinuity analysis

Sunil A. Sheth, Hamzah Saei, Mahmoud H. Mohammaden, Jonathan Andrew Grossberg, Italo Linfante, David S. Liebeskind, Kara Christopher, Mohamad K. Abdalkader, Juan Vivanco‐Suarez, Mary Penckofer, Johanna T Fifi, Shahram Majidi, James Ernest Siegler, Ananya S. Iyyangar, Guillermo Linares, Rania Abdelkhaleq, Brijesh Mehta, Jaydevsinh N. Dolia, Wondwossen G. Tekle, Joy Sessa, Raul G. Nogueira, Diogo C Haussen, Ameer E Hassan, Youngran Kim, Mouhammad A. Jumaa, Taha Nisar, Aarón Rodríguez-Calienes, Milagros Galecio‐Castillo, Piers Klein, Gabrielle Valestin, Syed Ali Raza Zaidi, Sergio Salazar-Marioni, Santiago Ortega-Gutierrez, Aqueel Pabaney, A. Saleemi
article en
3 citations

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.

Scientific ReportsVol. 15(1)
Boston University (US), University of Iowa (US), Boston Medical Center (US), Grady Memorial Hospital (US), University of California, Los Angeles (US), ProMedica Toledo Hospital (US), Cooper Medical School of Rowan University (US), University of Texas Health Science Center at Dallas (US), Memorial Healthcare System (US), Valley Baptist Medical Center (US), The Cardiac and Vascular Institute (US), Memorial Regional Hospital (US), The University of Texas Health Science Center (US), Pittsburg State University (US), Saint Louis University (US), University of South Alabama (US), The University of Texas Health Science Center at Houston (US), Icahn School of Medicine at Mount Sinai (US)
National Institutes of Health
Openalex Percentile: Top 6%
Acute Ischemic Stroke Management
4.06
DOIOpen Access PDFOpenAlex
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