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O-010 Racial disparity in mechanical thrombectomy utilization: multicenter registry results from 2016–2020
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  1. A Wallace1,
  2. D Gibson1,
  3. K Asif2,
  4. D Sahlein3,
  5. S Warach4,
  6. T Malisch5,
  7. M Lamonte6
  1. 1Neurointerventional Surgery, Ascension Columbia St. Mary’s Hospital, Milwaukee, WI
  2. 2Neurointerventional Surgery, Ascension Columbia St. Mary’s Hospital, Arlington Heights, IL
  3. 3Neurological Surgery, Goodman Campbell Brain and Spine, Carmel, IN
  4. 4Neurology, University of Texas, Austin, TX
  5. 5Interventional Neuroradiology, AMITA Health Medical Group, Arlington Heights, IL
  6. 6Neurology, University of Maryland, Baltimore, MD

Abstract

Background and Purpose Previous studies on racial disparity in mechanical thrombectomy (MT) treatment of acute large vessel occlusion (LVO) stroke lacked individual patient data that influences treatment decision-making. We assessed patient-level data in a large United States healthcare system from 2016-2020 for racial disparities in MT utilization and eligibility.

Methods The following variables were extracted for all stroke patients presenting to 42 hospitals in 12 states between January 1, 2016-September 30, 2020: age, gender, race, median income and population density of residential zip code, stroke certification of presenting hospital, baseline ambulatory status, and NIH stroke scale. Multivariate logistic regression was used to analyze associations between each characteristic and the following dependent variables: (1) overall rate of treatment with MT; (2) proportion of patients arriving to the hospital within 5 hours of last known well (‘early arrival’); (3) proportion of early arrival patients with documented anterior circulation LVO (aLVO; ICA terminus, M1 or M2 occlusion); (4) rate of MT among early-arrival patients with documented aLVO.

Results The cohort included 34,596 patients: 26,640 White, non-Hispanic (‘White’; 77.0%) and 7,956 African American or Black (‘Black’; 23.0%). Black patients were less likely to undergo MT (aOR, 0.72; 95% CI 0.61-0.84; table 1), arrive within 5 hours of LKW (aOR, 0.73; 95% CI 0.68-0.78; table 2) and have documented aLVO (aOR, 0.70; 95% CI 0.58-0.84; table 3). Race was not associated MT among early arrival patients with documented aLVO (table 4).

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Abstract O-010 Table 1

Overall MT rates

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Abstract O-010 Table 2

Proportions of patients arriving within 5 hrs of LKW

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Abstract O-010 Table 3

Proportions of documented LVO among patients arriving within 5 hrs of LKW

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Abstract O-010 Table 4

MT rates among early arrival patients with a LVO

Conclusions Black stroke patients underwent MT less frequently than Whites, likely in part due to longer times from LKW to hospital arrival and a lower rate of documented aLVO. Further studies are needed to assess whether extending the MT time window and more aggressive LVO screening protocols mitigate this disparity.

Disclosures A. Wallace: None. D. Gibson: 2; C; iSchemaView, Medtronic, Siemens. K. Asif: None. D. Sahlein: 2; C; Medtronic, Microvention, Stryker, Phenox. 3; C; Medtronic. S. Warach: None. T. Malisch: None. M. Lamonte: None.

https://doi.org/10.1136/neurintsurg-2021-SNIS.10

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