Racial and ethnic disparities in endovascular treatment outcomes in acute ischemic stroke: a systematic review and meta-analysis

TL;DR

This study finds racial and ethnic disparities in outcomes after stroke treatment, with Hispanic patients facing worse recovery and White patients having higher mortality.

Contribution

The study provides new evidence that disparities in stroke treatment outcomes are influenced by post-procedural and systemic factors.

Findings

Hispanic patients had higher odds of poor functional recovery after endovascular therapy.

White patients had higher 90-day mortality compared to non-White patients.

Disparities are linked to post-stroke care rather than the procedure itself.

Abstract

This meta-analysis aims to evaluate whether racial and ethnic disparities exist in outcomes following endovascular therapy (EVT) for acute ischemic stroke (AIS).

A systematic literature search was conducted through June 2024. We used Review Manager to pool data and calculate odds ratios (ORs) for categorical outcomes and mean differences (MDs) for continuous outcomes, all reported with 95% confidence intervals (CIs). Our primary outcomes of interest were functional recovery and mortality 90 days after stroke.

Eleven studies involving 49,040 patients were included. Compared to non-Hispanic patients, Hispanic patients had significantly higher odds of poor functional recovery (mRS 3–6) at 90 days (OR: 1.54; 95% CI 1.20–1.98; P < 0.01), though mortality and sICH rates were similar. When comparing White and non-White patients, White patients had significantly higher 90-day mortality (OR: 1.36; 95% CI 1.15–1.60; P < 0.01), with no significant differences in sICH, recanalization success, or long-term functional recovery.

Disparities in EVT outcomes for AIS appear to be driven more by post-procedural and systemic factors than by differences in the procedure itself. Hispanic patients face worse functional recovery despite similar acute outcomes, suggesting barriers in post-stroke care. Improved access to rehabilitation and culturally tailored support may help close these gaps.

The online version contains supplementary material available at 10.1007/s00415-025-13427-z.

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