By Matthew E. Fink, MD
Louis and Gertrude Feil Professor and Chair, Department of Neurology; Associate Dean for Clinical Affairs, NewYork Presbyterian/Weill Cornell Medical College
Dr. Fink reports no financial relationships relevant to this field of study.
Mechanical thrombectomy for the treatment of acute ischemic stroke secondary to large vessel occlusion has been accepted and widely deployed in hospitals throughout the United States. However, disparities of treatment across various ethnic and racial groups has not been examined carefully to ensure uniform application of this treatment. The investigators reviewed admissions for acute ischemic stroke to endovascular centers occurring between January 2016 and September 2018 from a national database. They determined the number of patients who were treated with intravenous thrombolysis as well as mechanical thrombectomy at each institution, and recorded patient demographics, including age, sex, race, ethnicity, and insurance status. Demographic variables independently associated with utilization of mechanical thrombectomy were identified using a multivariate linear regression analysis.
There were 206,853 admissions to 173 endovascular centers during the time interval that was explored. Overall utilization of mechanical thrombectomy was 8.4% of acute ischemic stroke patients. The utilization of endovascular mechanical thrombectomy for black and Hispanic patients was lower than among white and non-Hispanic patients (7.0% vs. 9.8%). Black and Hispanic patients also were less likely to receive intravenous thrombolysis (16.2% vs. 20.5%), or to be admitted to the endovascular center after transfer (20% vs. 30%). In a multivariate linear regression analysis, it was determined that presence of female sex, uninsured status or insurance with Medicaid, and having black or Hispanic race/ethnicity were independently associated with a lower utilization of mechanical thrombectomy. Stroke centers need to address these disparities and focus on the underlying causes that explain them.