Abstract TP94: Exploring Trends in LVO EVT Treatment of Fringe Patients by Race

Abstract

Intro & Background: 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 & Materials: 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: 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. Conclusion: The overall fringe population showed greater percentage of the white population which we speculate leads to higher percentage of white population in the SICH criteria, they are receiving more off-guideline treatment. 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.