For large vessel acute ischemic stroke, women are less likely to be routed to comprehensive stroke centers

At the onset of large vessel acute ischemic stroke, women are less likely than men to be routed immediately to comprehensive stroke centers, researchers reported on July 18 in the Journal of the American Heart Association.

“Timely treatment of stroke is incredibly important; the faster a doctor is able to get the vessel open, the better the patient’s chance of having a good outcome, said investigator Sunil Sheth MD, associate professor of neurology and director of the vascular neurology program with McGovern Medical School at the University of Texas in Houston “These routing systems in hospitals are designed to get patients to the best care as quickly as possible,” Sheth added. “We don’t know exactly why women were less likely than men to be routed to comprehensive stroke centers, but we do know that gender is an implicit bias. Getting to the granular level of what went into a hospital’s routing decision will be very important for future studies.”

As background, the authors noted that, “Large vessel occlusion stroke occurs when a major artery in the brain is blocked. They are considered one of the more severe kinds of strokes, accounting for an estimated 24% to 46% of acute ischemic strokes.”

From January 2019 to June 2020, the investigators identified consecutive patients in the Houston area with large vessel occlusion acute ischemic stroke. They compared prehospital routing of men versus women to centers in which it was possible to have endovascular therapy remove the clot blocking the artery.

Of the 503 patients presenting with large vessel occlusion stroke, 82% were routed to comprehensive stroke centers, and 46% of the patients were women.

The women were older (73 versus 65) and presented with greater National Institutes of Health Stroke Scale score (14 versus 12, meaning their symptoms were worse).

After the investigators adjusted the data for differences in stroke type, age, travel distance, and other relevant factors, they found that women with large vessel occlusion acute ischemic stroke were 9% less likely than men to be routed to comprehensive stroke centers.

The authors concluded. “Despite presenting with more significant stroke syndromes and living within comparable distance to CSCs [comprehensive stroke centers], women with LVO AIS [large vessel occlusion acute ischemic stroke] were less likely to be routed to CSCs compared with men. Further study of the mechanisms behind this disparity is needed.”

Investigator and author Youngran Kim. PhD, assistant professor of management, policy, and community health at the University of Texas in Houston School of Public Health, added “Older age at onset and severe stroke in women, compounded by a higher likelihood of age-related risk factors, can contribute to the higher rate of death from stroke and higher risk for disability after stroke in women, Therefore, appropriate triage and prehospital routing can be even more critical for women. Whether large vessel occlusions in women are less likely to be identified using current screening tools due to older age, premorbidity, or nontraditional symptoms needs to be investigated.”