Racial Disparities in Stroke Treatment Evaluated in Studies at SNIS

July 27, 2021—The Society of NeuroInterventional Surgery (SNIS) announced the presentation of findings from two studies of racial disparities in stroke treatment in the United States.

One study demonstrated that Black patients are less likely than White patients to undergo thrombectomy to remove blood clots from arteries in the brain. The second study showed that race, in combination with other factors, predicted how quickly individuals with stroke got to stroke centers to receive necessary thrombectomy. The faster patients who need thrombectomy receive it, the better their chances are of avoiding death or long-term disability from stroke, noted SNIS.

The studies were presented at the SNIS 18th annual meeting held July 26-30 in Colorado Springs, Colorado.

First, “Racial Disparity in Mechanical Thrombectomy Utilization: Multicenter Registry Results from 2016-2020” analyzed the records of 34,596 patients across 5 years, 42 hospitals, and 12 states.

As summarized by SNIS, the investigators found the following:

• Black stroke patients were 28% less likely than White patients to receive thrombectomy care
• Black stroke patients were 27% less likely than White patients to arrive at the hospital within 5 hours of stroke onset
• Black stroke patients were 30% less likely to be diagnosed with blockage of a large artery in the brain when they arrived at the hospital

The SNIS announcement noted that the investigators advised that further research is needed to assess whether these disparities can be reduced by community stroke education, technologies that allow thrombectomy to be performed later after stroke onset, and more aggressive patient screening for brain artery blockages.

“Black patients in the United States consistently experience worse health outcomes than White patients, leading to staggering racial health gaps,” commented lead author Adam Wallace, MD, in the SNIS press release. “It’s imperative that we take steps to ensure that all stroke patients are treated with the utmost urgency and receive optimal care, including surgery when appropriate, so they can experience the highest quality of life after stroke.” Dr. Wallace is a neurointerventional surgeon at Ascension Columbia St. Mary’s Hospital in Milwaukee, Wisconsin.

Next, “Disparities in Stroke: Influence of Socioeconomic Status and Race on Timely Access to Mechanical Thrombectomy” reviewed data for 305 patients collected between 2016 and 2020. The investigators sought to determine how factors including race, socioeconomic status, health insurance coverage, and driving distance to a stroke center influenced how quickly individuals were able to receive needed stroke surgery.

According to SNIS, the study investigators measured the time between each patient’s stroke onset and the beginning of surgery, with a focus on the time from onset to arrival at the hospital.

The investigators found that race was among the predictors for how quickly patients made it to a stroke center, which impacts how quickly they can have surgery. Other factors included driving distance, the patient’s stroke severity level, and whether a patient discovered the stroke symptoms upon waking.

Income, age, and gender were not found to be predictors for timely access to care among this group of patients, noted the SNIS announcement.

“Your race, ZIP code, or socioeconomic status should not determine whether you make it home from the hospital after a stroke,” commented the study’s lead author Ricardo Hanel, MD, in the SNIS announcement. “This study shows that equity of access to care is critically important in achieving excellent outcomes for all.” Dr. Hanel is an endovascular neurosurgeon and Co-medical Director of the Baptist Stroke & Cerebrovascular Center in Jacksonville, Florida.