Impact of Race, Gender, and Insurance Status on Outcomes Following Endovascular Treatment for Acute Ischemic Stroke

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Abstract Background Racial, gender, and socioeconomic disparities in stroke outcomes are well documented, but their impact on procedural success and clinical outcomes after endovascular treatment (EVT) for acute ischemic stroke remains unclear. Methods We retrospectively analyzed 584 acute ischemic stroke patients who underwent EVT (2016-2023), evaluating procedural reperfusion (TICI 2B-3), stroke severity (NIHSS/mRS) at admission and discharge, functional outcomes at discharge and 90 days (mRS), discharge disposition, and thrombolysis (tPA) administration. Multivariable logistic regression assessed independent predictors of outcomes. Results Successful reperfusion was achieved in 90.8%, with no significant differences by race, gender, or insurance status. Black patients and Medicare-insured individuals presented with significantly greater stroke severity (NIHSS ≥9, p<0.05). Poor functional outcomes (mRS 3-6) at discharge and 90 days were significantly higher among Black patients, females, and Medicare-insured patients (p<0.05). Medicare and Medicaid patients were more frequently discharged to non-home settings. Insurance status was significantly associated with lower likelihood of tPA administration (p=0.006). Logistic regression showed that initial stroke severity strongly predicted outcomes, while procedural success was uniform across demographic groups. Conclusions Procedural success of EVT was equitable; however, disparities persisted in stroke severity at admission and long-term outcomes. These findings highlight the need for systemic interventions addressing pre-hospital care, prevention, and equitable post-stroke rehabilitation access.

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