Abstract TP55: Racial And Gender Disparities In Patients Undergoing Mechanical Thrombectomy At A Comprehensive Stroke Center

Abstract

Introduction: Mechanical thrombectomy is the standard of care for acute ischemic stroke for select patients with large vessel occlusion (LVO). Racial and gender disparities exist in the incidence, morbidity, and mortality related to stroke. Furthermore, racial disparities in the utilization of thrombectomy have been previously identified. However, disparities in the utilization of thrombectomy in a single center with a standardized patient selection protocol have not been described. Methods: Using the American Heart Association Quality Improvement Programs Registry, we retrospectively reviewed the records of 1,143 patients with LVO between December 1, 2014, and May 31, 2021. Patient records were assessed for demographic data, stroke risk factors, process metrics, and success of thrombectomy. A Pearson’s Chi-Squared and an Independent two-sample T-test were used to determine significance. Results: Of the 1,143 LVO patients, 50.4% were female, 49.6% were male, 84.3% were white, 15.7% were nonwhite. Males were more likely to have diabetes compared to females (22.8% versus 17.9%; p=0.044). There were no significant differences based on race for stroke risk factors including diabetes and atrial fibrillation. Patient selection for thrombectomy was determined by a protocol agnostic to gender and race. Female patients were more likely to undergo thrombectomy compared to males (62.4% versus 48.9%; p<0.001). White patients were more likely to undergo thrombectomy compared to nonwhites (58.7% versus 39.7%; p<0.001). White patients were more likely to have a shorter interval between their last known well (LKW) to arrival (454 minutes versus 533 minutes; p=0.008) despite the fact our nonwhite patients were more likely to originate from our local county (58.1% versus 8.3%; p<0.001). Conclusions: In our analysis of LVO patients, female patients and white patients were more likely to undergo mechanical thrombectomy. The higher incidence of diabetes in males may have resulted in the patients presenting with a larger core infarct, making them ineligible for thrombectomy. Further investigation with data from multiple centers will be necessary to validate these findings and identify strategies for improving utilization of thrombectomy.