Stroke: Endovascular therapy, is there a difference between black and white Americans?

Endovascular therapy (EVT) is a highly impactful treatment for selected patients with acute ischemic stroke
(AIS) with large vessel occlusion (LVO) .

Vascular stroke

However, effective screening and implementation of EVT relies on professional competence, not every hospital caring for AIS patients can do it
.

In a previous study examining selected hospital subgroups, black patients were less likely to receive intravenous recombinant tissue-type plasma protein activator (IV tPA) and EVT compared with white patients

screening

To assess this question more completely, Youngran Kim et al.
of Harvard University used a full-sample dataset that captured all patients treated during the study period across the state, regardless of hospital type
.

They examined access to and utilization of EVT for AIS by ethnicity and validated their findings in an independent national sample

They conducted a retrospective, population-based study using the 2019 Texas Inpatient Public Use Data File
.

Acute ischemic stroke cases and EVT use were determined using diagnostic and procedural codes from the International Classification of Diseases, tenth revision (ICD-10)

diagnosis

They examined EVT use by race/ethnicity and performed patient- and hospital-level analyses
.

To validate the state-by-state findings, a patient-level analysis was performed using the 2017 national sample of hospitalized patients to obtain national estimates

Of the 40,814 acute ischemic stroke cases in Texas in 2019, 54% were white, 17% were black, and 21% were Hispanic
.

Black patients had similar EVT performance hospital admissions and more comprehensive stroke centers (CSCs) compared with white patients (EVT 62% vs 62%, P=0.

 

EVT rates did not differ between Hispanic and white patients
.

The lower EVT rate among black patients was consistent in the subgroup who arrived at an early time window and received intravenous recombinant tissue-type plasma protein activator (adjusted relative risk, 0.

Data from a nationwide sample confirmed the finding that black patients had less EVT use (adjusted relative risk, 0.
87 [0.
77-0.
98], P=0.
024)
.

Nationwide sample data corroborates finding that black patients utilize less EVT

The significance of this study lies in its findings: There were no differences in visits to hospitals or CSCs where EVT was performed; however, EVT use was lower in black patients
.

There were no differences in visits to hospitals or CSCs where EVT was performed; however, EVT use was lower in black patients
.

Original source:
Kim Y, Sharrief A, Kwak MJ, et al.

Underutilization of Endovascular Therapy in Black Patients With Ischemic Stroke: An Analysis of State and Nationwide Cohorts.
Stroke.

Underutilization of Endovascular Therapy in Black Patients With Ischemic Stroke: An Analysis of State and Nationwide Cohorts.
Stroke.
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