Effect of Hispanic Status in Mechanical Thrombectomy Outcomes after Ischemic Stroke: Insights from STAR

Joshua D. Burks, Stephanie H. Chen, Evan M. Luther, Eyad Almallouhi, Sami Al Kasab, Pascal M. Jabbour, Stacey Q. Wolfe, Kyle M. Fargen, Adam S. Arthur, Nitin Goyal, Isabel Fragata, Ilko Maier, Charles Matouk, Jonathan Grossberg, Peter Kan, Clemens Schirmer, R. Webster Crowley, William Ares, Christopher S. Ogilvy, Ansaar T. RaiMichael R. Levitt, Maxim Mokin, Waldo Guerrero, Min S. Park, Justin Mascitelli, Albert Yoo, Richard W. Williamson, Andrew Grande, Roberto Crosa, Sharon Webb, Marios Psychogios, Eric C. Peterson, Dileep R. Yavagal, Alejandro M. Spiotta, Robert M. Starke

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background and Purpose: Epidemiological studies have shown racial and ethnic minorities to have higher stroke risk and worse outcomes than non-Hispanic Whites. In this cohort study, we analyzed the STAR (Stroke Thrombectomy and Aneurysm Registry) database, a multi-institutional database of patients who underwent mechanical thrombectomy for acute large vessel occlusion stroke to determine the relationship between mechanical thrombectomy outcomes and race. Methods: Patients who underwent mechanical thrombectomy between January 2017 and May 2020 were analyzed. Data included baseline characteristics, vascular risk factors, complications, and long-term outcomes. Functional outcomes were assessed with respect to Hispanic status delineated as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic patients. Multivariate analysis was performed to identify variables associated with unfavorable outcome or modified Rankin Scale ≥3 at 90 days. Results: Records of 2115 patients from the registry were analyzed. Median age of Hispanic patients undergoing mechanical thrombectomy was 60 years (72-84), compared with 63 years (54-74) for NHB, and 71 years (60-80) for NHW patients (P<0.001). Hispanic patients had a higher incidence of diabetes (41%; P<0.001) and hypertension (82%; P<0.001) compared with NHW and NHB patients. Median procedure time was shorter in Hispanics (36 minutes) compared to NHB (39 minutes) and NHW (44 minutes) patients (P<0.001). In multivariate analysis, Hispanic patients were less likely to have favorable outcome (odds ratio, 0.502 [95% CI, 0.263-0.959]), controlling for other significant predictors (age, admission National Institutes Health Stroke Scale, onset to groin time, number of attempts, procedure time). Conclusions: Hispanic patients are less likely to have favorable outcome at 90 days following mechanical thrombectomy compared to NHW or NHB patients. Further prospective studies are required to validate our findings.

Original languageEnglish (US)
Pages (from-to)E715-E719
JournalStroke
Volume52
Issue number11
DOIs
StatePublished - Nov 1 2021

Bibliographical note

Funding Information:
Dr Starke’s research is supported by Neurosurgery Research and Education Foundation (NREF), Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and National Institutes of Health (NIH; R01NS111119-01A1) and (UL1TR002736, KL2TR002737), Miami Clinical and Translational Science Institute, National Center for Advancing Translational Sciences, National Institute on Minority Health and Health Disparities. Consulting agreements with Penumbra, Abbott, Medtronic, InNeuroCo, Cerenovus. Dr Spiotta reports consulting Cerenovus, Terumo, Siemens, Penumbra, Stryker and reports eesearch support from Penumbra, Medtronic, Stryker. Dr Yoo’s research is supported by Medtronic, Cerenovus, Penumbra, and Stryker; reports consulting with Penumbra, Cerenovus, and Vesalio; and reports equity in Insera Therapeutics. Dr Grossberg’s research is supported by Georgia Grant Alliance and also reports consulting with Cognition Medical. Dr Kan reports consulting with Stryker and Imperative Care. Dr Crowley reports consulting with Medtronic and Cerenovus. Dr Levitt’s research is supported by Medtronic, Styker, Philips; reports consulting with Medtronic, Minnetronix, Metis Innovative; and reports equity in Synchron, Cerebrotech, and eLoupes. Dr Mokin’s research is supported by NIH; reports consulting with Medtronic and Cerenovus; and reports equity in Serenity medical, Synchron, and Endostream. Dr Yavagal consulting for Medtronic, Cerenovus, Poseydon, Rapid Medical, Vascular Dynamics, NeuroSave. The other authors report no conflicts.

Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • atrial fibrillation
  • ethnicity
  • hypertension
  • multivariate analysis
  • risk
  • stroke
  • thrombectomy

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