This study explores racial and ethnic differences in 1) receiving tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT) as treatment for ischemic stroke and 2) outcomes and quality of care after use of tPA or EVT in the United States. 

Strokes are a leading cause of mortality and long-term disability in the US. While strokes can occur in any population, there are racial and ethnic discrepancies in stroke incidence and post-stroke outcomes nationally. 

An observational analysis of 89,035 ischemic stroke patients from the 2019 National Inpatient Sample was conducted. We performed weighted logistic regressions between race and ethnicity and 1) tPA and EVT utilization and 2) in-hospital mortality. We also performed a weighted Poisson regression between race and ethnicity and hospital length of stay (LOS) after tPA or EVT. 

Black patients had significantly lower odds of receiving tPA and EVT than White patients, and minority populations (including but not limited to Black, Hispanic, Pacific Islander, Native American, and Asian) had significantly longer hospital LOS after treatment with tPA or EVT than White patients. We failed to find a significant difference between race or ethnicity and in-hospital mortality post-tPA or EVT.  

Black ischemic stroke patients were less likely to receive tPA and EVT than White patients, and among patients who received tPA or EVT, minority patients had significantly longer hospital LOSs than White patients. While we failed to find a difference in in-hospital mortality, racial and ethnic disparities are still evident in the decreased usage of tPA and EVT and longer LOSs for minority patients. This study calls for interventions to expand the utilization of tPA and EVT and advance quality of care post-tPA or EVT in order to improve stroke care for minority patients.