Racial and Ethnic Disparities in the Utilization of Thrombectomy for Acute Stroke

Abstract

Background and Purpose— Racial and ethnic disparities in the access to mechanical thrombectomy (MT) for treatment of acute ischemic stroke (AIS) secondary to large vessel occlusion have been previously described. The effect of recent randomized trials validating MT as an effective therapy for AIS secondary to large vessel occlusion on such disparities has not been investigated. Methods— Information on admissions for AIS to endovascular centers occurring between January 2016 and September 2018 was obtained from a national database. The number of patients receiving IV-tPA (intravenous tissue-type plasminogen activator) and MT at each institution was determined, and patient demographics were characterized according to age, sex, race/ethnicity, and insurance status. Comparisons of patients who did and did not undergo MT and between patients of different racial and ethnic backgrounds were performed. Demographic variables independently associated with the utilization of MT were identified using multivariate linear regression analysis. Results— There were 206 853 admissions to 173 endovascular centers during the time period of interest. The overall utilization of MT was 8.4%. The utilization of MT for black/Hispanic patients was lower than that among white/non-Hispanic patients (7.0% versus 9.8%; P <0.001). Black/Hispanic patients were also less likely to receive IV-tPA (16.2% versus 20.5%; P <0.001) and to be admitted to the endovascular center after transfer from a different hospital (20.0% versus 30.1%; P <0.001). On multivariate linear regression analysis, increasing institutional proportions of patients with female sex (β=−0.601; P <0.001), insurance with Medicaid or uninsured status (β=−0.153; P =0.029), and black/Hispanic race/ethnicity (β=−0.062; P =0.046) were independently associated with lower institutional utilization of MT. Conclusions— Despite the mainstream acceptance of MT for the treatment of AIS secondary to large vessel occlusion, racial and ethnic disparities in the utilization of MT persist.

Immune responses to stroke: mechanisms, modulation, and therapeutic potential

“…28, 29, and Table 1). While remarkably effective, these treatments can be administered to fewer than 10% of stroke patients because of exclusion criteria, hemorrhagic complications, and highly specialized resources required for thrombectomy (30). However, advances in imaging the penumbra may provide the opportunity to rescue salvageable tissue using noninterventional means.…”

Delays in presentation and mortality among Black patients with mechanical thrombectomy after large-vessel stroke at a US hospital

“…However, recent nationwide studies have demonstrated racial and ethnic disparities in the use of mechanical thrombectomy for stroke. 1,28,29 These studies acknowledge that the disparity in use of mechanical thrombectomy may be attributed to preadmission factors, such as delayed time from stroke onset to hospital presentation. Our results show that the mean time from stroke onset to hospital presentation for Black patients was almost twice that for White patients.…”

“…27 Several studies have demonstrated a racial disparity in the use of thrombectomy and outcomes among patients with acute stroke after an emergent large-vessel occlusion. 1,28,29 The identification and correction of the sources of this disparity are essential. In this study, we compared stroke outcomes between Black and White patients who underwent mechanical thrombectomy for a stroke at our institution.…”

Sphingosine-1-Phosphate Signaling in Ischemic Stroke: From Bench to Bedside and Beyond

“…Despite a series of clinical trials with neuroprotective drugs, current treatment options remain limited to thrombolysis and mechanical recanalization for the acute phase of ischemic stroke ( Powers, 2019 ). While effective, the treatments can only be applied to less than 10% of patients for a narrow treatment time window and strict exclusion criteria ( Rinaldo et al, 2019 ). Moreover, even a successful recanalization may lead to enlarged infarction due to ischemic-reperfusion (IR) injury ( Mizuma et al, 2018 ).…”