Abstract TP147: Investigating Potential Racial And Ethnic Biases In Mechanical Thrombectomy Selection For Expanded Indication Populations

Introduction: Endovascular thrombectomy (EVT) performance in clinical practice has grown substantially, including in patient groups previously excluded from clinical trials such as those with advanced age, lower Alberta Stroke Program Early CT Score (ASPECTS) and distal occlusions. However, the access and utilization of EVT in these non-randomized controlled trial (RCT) supported populations across different racial and ethnic groups remains incompletely characterized Methods: Using our prospectively maintained multi-center registry which includes four comprehensive stroke centers around the greater Houston area, we identified patients with large vessel occlusion (LVO) acute ischemic stroke (AIS). Patients were included if LVO was confirmed by non-invasive vascular imaging. The primary outcome was rate of performance of EVT in patients with low ASPECTS (0-5), advanced age (> 80), and distal occlusion (M2 and beyond) by race and was determined by Fisher’s exact test. Results: Among 2,614 patients with LVO AIS, 1,239 (47%) were female, median NIHSS was 13 [interquartile range 5-20], ASPECTS was 9 [7-10]. 28% of the cohort was black, 52% white and 4% Hispanic. The most common occlusion locations were M1 MCA (34%) and M2 MCA (19%). Among the 538 patients aged > 80 years old, 232 (43%) underwent EVT. There were no significant differences in the proportions of patients treated by race (43% white vs 43% black, p=1) . Among 175 patients with ASPECTS 0-5, 59 (34%) underwent EVT. There were no significant differences in the proportions of patients treated by race (44% white vs 35% black, p=0.37). Among 760 patients with occlusion of M2 and beyond, 224 (30%) underwent EVT. There were no significant differences in the proportions of patients treated by race (33% white, 29% black, p=0.28). Conclusion: In this registry from a diverse urban population, we did not identify disparities in EVT performance in patients with non-RCT supported indications by race. Further studies in other clinical settings will be important.