Abstract TP93: Interaction Of Ethnicity And Arrival Method On Thrombectomy Delay: The Society Of Vascular And Interventional Neurology Multicenter Collaboration

Abstract

Introduction: Compared to White patients, non-White minority populations are less likely to receive acute treatment for ischemic stroke, and when they do, it can be delayed. Hypothesis: To evaluate the interaction between arrival method (transfer vs. emergency medical services [EMS] vs. private vehicle) and race/ethnicity (non-Hispanic Black [NHB] vs. non-Hispanic White [NHW] vs. Hispanic) on door-to-arterial puncture (DTAP) time in thrombectomy. Methods: Multicenter retrospective cohort study of consecutive patients (≥18 years) treated with endovascular thrombectomy at 14 US Comprehensive Stroke Centers (1/1/2019-07/31/2020). Door (arrival) to arterial puncture (DTAP) was evaluated using a linear mixed model to estimate the effect of race/ethnicity and arrival mode on treatment time. Results: Of the 1,908 included patients, 356 (19%) of whom were Hispanic, stroke severity was similar between race/ethnicity groups, however Hispanic and NHB patients experienced significant delays in DTAP compared to NHWs (adjusted β Hisp = 0.32, 95%CI 0.08-0.55; β NHB = 0.23, 95%CI 0.04-0.41). In the final linear mixed model, more severe neurologic deficits were associated with shorter DTAP (β NIHSS per point -0.03, 95%CI -0.04- -0.03), and arrival via EMS or private vehicle versus transfer were associated with longer delays (β EMS = 0.57, 95%CI 0.41-0.74; β PV = 1.27, 95%CI 0.85-1.70). There was a significant interaction between Hispanic ethnicity and arrival by EMS (p=0.03) or private vehicle (p=0.04) in a direction favoring shorter treatment delays. Conclusions: Endovascular therapy is delayed in Hispanic and NHBs when compared to NHWs. While arrival by EMS or private vehicle (vs. inter-hospital transfer) also contributed to treatment delays, Hispanic ethnicity modified this effect such that there was less delay in DTAP. This may be related to communication barriers between caregivers and healthcare providers when a patient is suddenly disabled from stroke.