Racial Disparities in EVT Access, Forced Exercise Impact on Poststroke Patients, EVT Benefits Within 24 Hour Window

This week's Neurology News Network covered a trio of studies presented at the International Stroke Conference 2021, March 15–18. More specifically, we look at the disparities across racial and ethnic groups with access to endovascular thrombectomy, the use of forced exercise on poststroke patients, and the benefits endovascular thrombectomy has in the 6- to 24-hour window.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus. This week’s episode is centered around the recently concluded International Stroke Conference.

Findings from the Get With The Guidelines (GWTG)-stroke clinical trial demonstrated that endovascular therapy (EVT) utilization has increased across all race/ethnic groups since the treatment was validated in 2015, but disparities still remain. Between April 2012 and June 2019, 14% (n = 42,422) of a cohort of 302,965 potentially eligible patients received EVT and, in all groups, EVT increased over the course of time. Despite these increases, Black patients were 32% less likely to receive EVT before and still 17% less likely to receive it from 2015 on when compared to non-Hispanic White (NHW) patients. At discharge, both mRS and ambulation were no different between the groups. Better short-term outcome among minorities was attributed to improving access to acute stroke care following the 2015 publications, as well as different attitudes towards end-of-life care among NHW compared with minorities. Although, 3 months later, Black and Asian patients were 16% and 30% less likely to be able to function independently compared to NHW patients.

Data from a prospective cohort study presented at the American Stroke Association’s (AHA) International Stroke Conference (ISC) 2021, revealed that lower extremity motor function is improved with high-rate forced exercise (FE) in poststroke patients.Senior author Jay Alberts, PhD, The Edward F. and Barbara A. Bell Family Endowed Chair, Cleveland Clinic Lerner Research Institute, and colleagues also concluded that these improvements may, in part, be due to externally altered proprioceptive feedback in FE enhancing cortical engagement. Individuals with chronic hemiparesis underwent 24 sessions of an FE cycling intervention at a cadence of at least 80 revolutions per minute. At the end of the 8-week period, participants demonstrated improved gait velocity from 0.44 m/s to 0.58 m/sec, exceeding the minimally clinically important difference for chronic stroke survivors. In addition to improved gait velocity, patients increased cadence by 9.4 steps/min, as well as increased right and left stride length by 6.7 cm and 8.2 cm, respectively. Other improvements in spatiotemporal characteristics such as step width were decreased by 2.4 cm, as well as single limn stance time, which was decreased by 0.2 seconds.

Data from a recent study suggest that endovascular thrombectomy (ET) benefits patients with acute ischemic stroke (IS) across the 6- to 24-hour time window.In the AURORA collaboration, the researchers analyzed data from 6 randomized trials that examined ET in anterior circulation proximal large vessel occlusion (LVO) stroke beyond 6 hours and up to 24 hours from time last seen well (TSLW). They sought to more precisely define the point estimate of ET benefit and address remaining questions regarding subgroups through meta-analysis of individual patient data. The researchers found that 81.0% (n = 216) of ET patients had successful revascularization. No significant differences were seen in mortality between intervention and control groups, or symptomatic intracerebral hemorrhage between intervention and control groups.

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