Political Barriers in Equitable Ischemic Stroke Care in the Post-Endovascular Mechanical Thrombectomy Clinical Trial Era

Ischemic stroke is a significant cause of mortality and disability in the United States, affecting nearly a million patients annually. In 2015, several randomized controlled trials revealed the efficacy of endovascular mechanical thrombectomy (EVT) – a procedure to remove a blood clot obstructing blood flow to the brain - in treating this condition. This breakthrough profoundly impacted the field of ischemic stroke care, transforming treatment protocols globally. Despite these advances, not all patients have equal access to care, resulting in poorer outcomes for some. To further study disparities in ischemic stroke care, the National Inpatient Sample database was queried to identify ischemic stroke patients between 2015 and 2019. The study focused on six dependent variables: mortality rate, length of stay, total charges, daily charges, adverse discharge, and if the patient received EVT. Independent variables included the patient's socio-economic status, stroke severity, locality, and more. The results from the regression models suggested that certain demographics of ischemic stroke patients face disproportionately adverse outcomes. A comparison of the results to establish literature is provided and a discussion of potential policy solutions is provided. The findings of this study are critical in understanding the political barriers to equitable ischemic stroke care in the aftermath of the thrombectomy clinical trials. By evaluating disparities in ischemic stroke care, this study provides insight into potential policy solutions to mitigate observed disparities and ensure equitable access to lifesaving ischemic stroke treatments for all.