Endovascular Therapy and Ethnic Disparities in Stroke Outcomes

被引：13

作者：

Bouslama, Mehdi

Rebello, Leticia C.

Haussen, Diogo C.

Grossberg, Jonathan A.

Anderson, Aaron M.

Belagaje, Samir R.

Bianchi, Nicolas A.

Frankel, Michael R.

Nogueira, Raul G. ^{[1
]}

机构：

[1] Emory Univ, Sch Med, 49 Jesse Hill Jr Dr SE,Room 333, Atlanta, GA 30303 USA

来源：

INTERVENTIONAL NEUROLOGY | 2018年 / 7卷 / 06期

关键词：

Acute stroke; Cerebral ischemia; Thrombectomy; Ischemic stroke; Cerebrovascular procedures; Quality and outcomes;

D O I：

10.1159/000487607

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose: Ethnic disparities in stroke are well described, with a higher incidence of disability and increased mortality in Blacks versus Whites. We sought to compare the clinical outcomes between those ethnic groups after stroke endovascular therapy (ET). Methods: We performed a retrospective review of the prospectively acquired Grady Endovascular Stroke Outcomes Registry between September 1, 2010 and September 30, 2015. Patients were dichotomized into two groups - Caucasians and African-Americans - and matched for age, pretreatment glucose level, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Baseline characteristics as well as procedural and outcome parameters were compared. Results: Out of the 830 patients treated with ET, 308 pairs of patients (n = 616) underwent primary analysis. African-Americans were younger (p < 0.01), had a higher prevalence of hypertension (p < 0.01) and diabetes (p = 0.04), and had higher Alberta Stroke Program Early CT Score values (p = 0.03) and shorter times to treatment (p = 0.01). Blacks more frequently had Medicaid coverage and less private insurance (29.6 vs. 11.4% and 41.5 vs. 60.3%, respectively, p < 0.01). The remaining baseline characteristics, including baseline NIHSS score and CT perfusion-derived ischemic core volumes, were well balanced. There were no differences in the overall distribution of 90-day modified Rankin scale scores (p = 0.28), rates of successful reperfusion (84.7 vs. 85.7%, p = 0.91), good outcomes (49.1 vs. 44%, p = 0.24), or parenchymal hematomas (6.5 vs. 6.8%, p = 1.00). Blacks had lower 90-day mortality rates (18 vs. 24.6%, p = 0.04) in univariate analysis, which persisted as a nonsignificant trend after adjustment for potential confounders (OR 0.52, 95% CI 0.26-1.03, p = 0.06). Conclusions: Despite unique baseline characteristics, African-Americans treated with ET for large vessel occlusion strokes have similar outcomes as Caucasians. Greater availability of ET may diminish the ethnic/racial disparities in stroke outcomes. (C) 2018 S. Karger AG, Basel

引用

页码：389 / 398

页数：10

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