Abstract 273: Exploring trends in LVO EVT treatment of fringe patients by race

Abstract

Introduction Following the publication of the randomized clinical trials in 2015 and 2018 on endovascular stroke therapy (EVT), procedural utilization has increased. Guidelines have since been developed and followed regarding cut‐offs for patient treatment eligibility. Here, we explore the trends in EVT treatment of patients categorized as “fringe” patients by race. Methods We performed a retrospective cross‐sectional analysis using the SVIN Registry with records from 2010 to 2021. This dataset includes all LVO AIS patients that underwent EVT. Patients were categorized as “fringe” or “non‐fringe” based on NIHSS (<6), ASPECTS (<6), pMRS (>1), proximal vs distal occlusion, last known well to arrival time (>24 hours), and age (>85). Fringe cutoffs were determined using typical guidelines. Outcomes were compared between White patients and Black/African American patients to determine trends in treating fringe patients with EVT. Chi‐squared analyses were utilized for outcomes. Results Among the 7,018 patients 4,791 patients were White and 1,821 patients were black. Median age was 69 (IQR: 58‐79). Median NIHSS was 17 (IQR: 11‐22). Focusing on the White and Black/AA patient population, a greater percentage of LVO patients that underwent EVT and were considered “fringe” were Black/AA patients (66% vs 71%). We also found that there are significant differences among these fringe categories categories: age, (20% vs 7.9%, p<0.001 white vs black), proximal occlusion (52% vs 58%, p<0.001, white vs black), and of having sICH (4.2% vs 2.8% p=0.03 white vs black). Comparing fringe categories between races, White patients were more likely to be >85 years of age, have a distal occlusion, and have sICH than Black/AA patients. Of note, while there was not a significant difference in last known well to CSC arrival times between the race groups, White patients were more likely to receive tPA (37% vs 30%, p<0.001, White vs Black/AA). Conclusion These findings indicate that there may be a presence of racial bias in treatment decision‐ making that should be further explored. Further, there is proof that indications for EVT interventions are being expanded past guidelines in order to provide treatment for a wider range of patients.