Alarming downtrend in mechanical thrombectomy rates in African American patients during the COVID-19 pandemic-Insights from STAR

• Authors: Sami Al Kasab, Medical University of South Carolina; Eyad Almallouhi, Medical University of South Carolina; Ali Alawieh, Emory University; Pascal Jabbour, Thomas Jefferson University Hospital; Ahmad Sweid, Thomas Jefferson University Hospital; Robert M Starke, University of Miami; Vasu Saini, University of Miami; Stacey Q Wolfe, Wake Forest School of Medicine; Kyle M Fargen, Wake Forest University; Adam S Arthur, Semmes Murphey Neurol & Spine Inst; Nitin Goyal, University of Tennessee; Abhi Pandhi, University of Tennessee; Ilko Maier, Univ Med Goettingen; Jonathan Grossberg, Emory University; Brian Howard, Emory University; Stavropoula Tjoumakaris, Thomas Jefferson University Hospital; Ansaar Rai, West Virginia University Hospitals; Min S Park, Barrow Neurological Institute; Justin R Mascitelli, Univ Texas Hlth Sci Ctr San Antonio; Marios N Psychogios, University Hospital Basel; Alejandro M Spiotta, Medical University of South Carolina
• Journal Title: JOURNAL OF NEUROINTERVENTIONAL SURGERY
• Volume: Volume 13, Number 4
• Publisher: BMJ PUBLISHING GROUP | 2021-04-01, Pages 304-307
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/neurintsurg-2020-016946
• Subjects: Health Sciences, Radiology; Health Sciences, Immunology; Biology, Microbiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Neuroimaging; Surgery; Neurosciences & Neurology; thrombectomy; stroke

Abstract

Background The coronavirus disease (COVID-19) pandemic has affected stroke care globally. In this study, we aim to evaluate the impact of the current pandemic on racial disparities among stroke patients receiving mechanical thrombectomy (MT). Methods We used the prospectively collected data in the Stroke Thrombectomy and Aneurysm Registry from 12 thrombectomy-capable stroke centers in the US and Europe. We included acute stroke patients who underwent MT between January 2017 and May 2020. We compared baseline features, vascular risk factors, location of occlusion, procedural metrics, complications, and discharge outcomes between patients presenting before (before February 2020) and those who presented during the pandemic (February to May 2020). Results We identified 2083 stroke patients: of those 235 (11.3%) underwent MT during the COVID-19 pandemic. Compared with pre-pandemic, stroke patients who received MT during the pandemic had longer procedure duration (44 vs 38 min, P=0.006), longer length of hospitalization (6 vs 4 days, P<0.001), and higher in-hospital mortality (18.7% vs 11%, P<0.001). Importantly, there was a lower number of African American patients undergoing MT during the COVID-19 pandemic (609 (32.9%) vs 56 (23.8%); P=0.004). Conclusion The COVID-19 pandemic has affected the care process for stroke patients receiving MT globally. There is a significant decline in the number of African American patients receiving MT, which mandates further investigation.