Stroke Recovery After Endovascular Therapy Differs by Race and Ethnicity

Racial and ethnic differences in functional outcomes, but not procedural success, are observed after endovascular therapy (EVT) for acute ischemic stroke (AIS), according to results of a systematic review and meta-analysis published in the Journal of Neurology.

Researchers conducted a comprehensive search of publication databases through June 2024 to identify studies reporting EVT outcomes by race and ethnicity. Their analysis included 11 retrospective cohort studies comprising 49,040 patients (mean age range, 63–72 years; 48%–54% women) who underwent EVT. Across studies, approximately 58% of participants were White, 26% were Hispanic, 11% were Black, and the remainder identified as Asian or other racial/ethnic groups.

Post-AIS mortality was higher among White patients compared with non-White patients (odds ratio [OR], 1.36; 95% CI, 1.15-1.60; I², 0%; P <.01), but no significant different was observed between Hispanic and non-Hispanic patients (OR, 1.09; 95% CI, 0.89-1.34; I², 0%; P =.38). Rates of symptomatic intracranial hemorrhage also did not differ significantly between Hispanic and non-Hispanic patients (OR, 1.33; 95% CI, 0.89-1.99; I², 29%; P =.16) or between White and non-White patients (OR, 0.77; 95% CI, 0.52-1.16; I², 0%; P =.21).

These results suggest that the disparities in outcomes are due to systemic barriers in follow-up care and rehabilitation.

Hispanic patients had higher odds of worse functional outcomes at 90 days, with a modified Rankin Scale (mRS) score of 3 to 6 (OR, 1.54; 95% CI, 1.20-1.98; I², 28%; P <.01). In contrast, achieving good functional outcome recovery, with an mRS of 0 to 2, at discharge (OR, 1.24; 95% CI, 0.38-4.04; I², 79%; P =.72) or at 90 days (OR, 1.07; 95% CI, 0.81-1.40; I², 0%; P =.64) did not differ between White and non-White patients.

The studies showed that EVT procedural success did not depend on race or ethnicity. Rates of successful recanalization remained similar across groups (OR, 1.17; 95% CI, 0.96-1.43; I², 14%; P =.12), and mean change in National Institutes of Health Stroke Score from admission to discharge showed no significant differences (mean difference, -0.30; 95% CI, -1.26 to 0.66; I², 50%; P =.44).

Study limitations include the reliance on self-defined race and ethnicity, and the lack of specific race and ethnicity data beyond White and Hispanic status.

The study authors concluded, “Our findings demonstrate that while EVT is performed with similar success and safety across racial and ethnic groups, disparities in post-procedural outcomes persist, particularly for Hispanic patients, who face worse functional recovery despite comparable acute care. These results suggest that the disparities in outcomes are due to systemic barriers in follow-up care and rehabilitation.”