Abstract Number ‐ 206: Evaluation of Disparities in Endovascular Treatment Times for Hispanics versus Non‐Hispanics
Authors: Van Orden Kimberlee , Torres Dolores , Meyer Dawn , Van Orden Kimberlee , Poynor Briana , Alwood Benjamin , Hailey Lovella , Agrawal Kunal 
Published: April 2023

Introduction

Endovascular therapy (EVT) within 24 hours from last known well (LKW) improves functional outcomes in acute ischemic stroke (AIS) with large vessel occlusion (LVO). Studies are limited in examining ethnic disparities in acute EVT revascularization times. The goal of this study is to evaluate disparities in EVT revascularization time metrics in Hispanic versus Non‐Hispanic ethnicity.

Methods

We retrospectively examined prospectively collected data from an IRB‐approved stroke registry at a certified, academic Comprehensive Stroke Center (CSC). The sample included AIS patients with acute large vessel occlusion (LVO) within 24 hours of LKW who underwent EVT between 1/1/2013 and 6/30/2022. Patients receiving IV rt‐PA prior to EVT were also included. Patients were excluded if the angiogram was diagnostic only or patient had comfort care measures initiated by Day 2. Categorical variables were analyzed via Chi‐squared, correlations, or frequencies as appropriate. We utilized a student’s t‐test to assess for between group differences following EVT for the CSC time metrics (in minutes): LKW‐to‐hospital arrival, LKW‐to‐groin puncture (GP), hospital arrival‐to‐GP, hospital arrival‐to‐revascularization, and GP‐to‐revascularization. Groups were defined as either Hispanic or Non‐Hispanic based on registry data capture. Analysis was adjusted for baseline NIHSS, baseline blood glucose, and age. A p‐value less than 0.05 was significant.

Results

A total of 411 patients at the CSC had an acute LVO and underwent emergent EVT. Thrombolysis was initiated prior to EVT in 67.5% of patients (n = 262). A total of 90 patients (21.9%) were transferred emergently from a CSC telemedicine site and had EVT. The mean age of the overall sample was 70 years ± 14, 47.2% of patients were female (n = 194), and the median initial NIHSS was 17 ± 8. The rate of Hispanic ethnicity in this sample was 29.4% (n = 121). There were no significant differences in baseline characteristics between Hispanic and Non‐Hispanic patients. In this study, there were no significant difference between Hispanics versus Non‐Hispanics for all EVT time metrics including: 1) LKW‐to‐hospital arrival (356 vs 370 minutes, 95% Confidence Interval [CI]: ‐62 to 89; p = 0.72); 2) LKW‐to‐GP (434 vs 475 minutes, 95% CI: ‐41 to 143; p = 0.327); 3) hospital arrival‐to‐GP (82 vs 103 minutes, 95% CI: ‐10 to 52; p = 0.185); 4) hospital arrival‐to‐revascularization (119 vs 138 minutes, 95% CI: ‐11 to 49; p = 0.221); or 5) GP‐to‐revascularization (37 vs 40 minutes, 95% CI: ‐1 to 8; p = 0.149).

Conclusions

In this study at a large, academic, certified Comprehensive Stroke Center with a considerable Hispanic population, there were no significant difference in EVT time metrics for Hispanic versus Non‐Hispanic patients. These results support the use of protocols, pathways, and stroke‐specific education utilized within the CSC framework to reduce treatment disparities and stroke burden across the diversity of AIS patients. Further studies must examine for disparities across ethnicities and race in time metrics at stroke centers located in various areas of the country to identify treatment disparities and implement plans to reduce those disparities with input from both healthcare teams and members of those groups.