Evaluating Outcome Associations with Race After Mechanical Thrombectomy: An Analysis of the NVQI-QOD Acute Ischemic Stroke Registry

Introduction: Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke (AIS) from large vessel occlusions (LVO). Racial differences in outcomes after MT for AIS have not been extensively studied. We aim to evaluate the real-world evidence for differences between race in the outcomes of thrombectomy for LVO using the NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD).

Methods: Data from the NVQI-QOD Acute Ischemic Stroke (AIS) registry database was analyzed and compared for racial differences in outcomes after MT in 4507 patients from 28 U.S. centers (17 states) between January 2014 to April 2021. Race was dichotomized into non-Hispanic White (NHW, n=3649) and non-Hispanic Black (NHB, n=858). We performed 1:1 propensity score matching resulting in a sub-sample of matched groups (n=761 each for NHB and NHW) to compare study endpoints using Welch’s two-sided t-tests and Chi-square test for continuous and categorical outcomes, respectively.

Results: Prior to matching, NHW and NHB patients significantly differed in age, comorbidities, medication usage, smoking status, and presenting stroke severity. In the unmatched cohort, NHB patients had higher average post-procedure length of stay (11.1 days vs 8.0 days, p< 0.0001) compared to NHW patients. Following matching, NHB patients continued to show higher average post-procedure length of stay (11.2 versus 9.1 days, p=0.004).

Conclusion : Evidence from the NVQI-QOD AIS registry suggests a disparity between NHW and NHB patients in post-procedure length of stay following MT; however, outcome metrics such as follow-up modified Rankin Score (mRS) and mortality did not differ significantly between racial groups.