RT Journal Article
SR Electronic
T1 Racial disparities in functional outcomes following mechanical thrombectomy in a cohort of patients with ischemic stroke
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP jnis-2023-020634
DO 10.1136/jnis-2023-020634
A1 Srinivas, Tara
A1 Ran, Kathleen
A1 Nair, Sumil K
A1 Hung, Alice
A1 Young, Christopher C
A1 Tamargo, Rafael J
A1 Huang, Judy
A1 Marsh, Elizabeth
A1 Hillis, Argye
A1 Yedavalli, Vivek
A1 Urrutia, Victor
A1 Gailloud, Philippe
A1 Caplan, Justin M
A1 Gonzalez, L Fernando
A1 Xu, Risheng
YR 2023
UL http://jnis.bmj.com/content/early/2023/08/02/jnis-2023-020634.abstract
AB Background Non-Hispanic Black (NHB) patients experience increased prevalence of stroke risk factors and stroke incidence compared with non-Hispanic White (NHW) patients. However, little is known about >90-day post-stroke functional outcomes following mechanical thrombectomy.Objective To describe patient characteristics, evaluate stroke risk factors, and analyze the adjusted impact of race on long-term functional outcomes to better identify and limit sources of disparity in post-stroke care.Methods We retrospectively reviewed 326 patients with ischemic stroke who underwent thrombectomy at two centers between 2019 and 2022. Race was self-reported as NHB, NHW, or non-Hispanic Other. Stroke risk factors, insurance status, procedural parameters, and post-stroke functional outcomes were collected. Good outcomes were defined as modified Rankin Scale score ≤2 and/or discharge disposition to home/self-care. To assess the impact of race on outcomes at 3-, 6-, and 12-months’ follow-up, we performed univariate and multivariate logistic regression.Results Patients self-identified as NHB (42%), NHW (53%), or Other (5%). 177 (54.3%) patients were female; the median (IQR) age was 67.5 (59–77) years. The median (IQR) National Institutes of Health Stroke Scale score was 15 (10–20). On univariate analysis, NHB patients were more likely to have poor short- and long-term functional outcomes, which persisted on multivariate analysis as significant at 3 and 6 months but not at 12 months (3 months: OR=2.115, P=0.04; 6 months: OR=2.423, P=0.048; 12 months: OR=2.187, P=0.15). NHB patients were also more likely to be discharged to rehabilitation or hospice/death than NHW patients after adjusting for confounders (OR=1.940, P=0.04).Conclusions NHB patients undergoing thrombectomy for ischemic stroke experience worse 3- and 6-month functional outcomes than NHW patients after adjusting for confounders. Interestingly, this disparity was not detected at 12 months. Future research should focus on identifying social determinants in the short-term post-stroke recovery period to improve parity in stroke care.Data are available upon reasonable request.