Impact of Race on Outcomes in the Endovascular and Microsurgical Treatment in Patients With Intracranial Aneurysms

Hidetoshi Matsukawa; Kazutaka Uchida; Mohammad-Mahdi Sowlat; Sameh Samir Elawady; Conor Cunningham; Ali Alawieh; Sami Al Kasab; Pascal Jabbour; Justin Mascitelli; Michael R Levitt; Hugo Cuellar; Waleed Brinjikji; Edgar Samaniego; Jan-Karl Burkhardt; Peter Kan; W Christopher Fox; Mark Moss; Mohamad Ezzeldin; Ramesh Grandhi; David J Altschul; Alejandro M Spiotta; Shinichi Yoshimura; STAR Registry Investigators

doi:10.1227/neu.0000000000002946

Impact of Race on Outcomes in the Endovascular and Microsurgical Treatment in Patients With Intracranial Aneurysms

Neurosurgery. 2024 Apr 23. doi: 10.1227/neu.0000000000002946. Online ahead of print.

Authors

Hidetoshi Matsukawa^{1

2}, Kazutaka Uchida^{1

2

3}, Mohammad-Mahdi Sowlat², Sameh Samir Elawady², Conor Cunningham², Ali Alawieh⁴, Sami Al Kasab⁵, Pascal Jabbour⁶, Justin Mascitelli⁷, Michael R Levitt⁸, Hugo Cuellar⁹, Waleed Brinjikji^{10

11}, Edgar Samaniego¹², Jan-Karl Burkhardt¹³, Peter Kan¹⁴, W Christopher Fox¹⁵, Mark Moss¹⁶, Mohamad Ezzeldin¹⁷, Ramesh Grandhi¹⁸, David J Altschul¹⁹, Alejandro M Spiotta², Shinichi Yoshimura¹; STAR Registry Investigators

Affiliations

¹ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
² Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
³ Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan.
⁴ Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
⁵ Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
⁶ Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.
⁷ Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
⁸ Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
⁹ Department of Neurosurgery and Neurointerventional Radiology, Louisiana State University, Shreveport, Louisiana, USA.
¹⁰ Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
¹² Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹³ Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadlphia, Pennsylvania, USA.
¹⁴ Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA.
¹⁵ Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
¹⁶ Department of Neuroradiology, Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville, Arkansas, USA.
¹⁷ Department of Clinical Sciences, University of Houston, HCA Houston Healthcare Kingwood, Houston, Texas, USA.
¹⁸ Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, Utah, USA.
¹⁹ Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, USA.

PMID: 38651917
DOI: 10.1227/neu.0000000000002946

Abstract

Background and objectives: The impact of race on outcomes in the treatment of intracranial aneurysm (IA) remains unclear. We aimed to investigate the relationship between race classified into White, Black, Hispanic, and other and treatment outcomes in patients with ruptured and unruptured IAs.

Methods: The study population consisted of 2836 patients with IA with endovascular treatment or microsurgical treatment (MST) from 16 centers in the United States and Asia, all participating in the observational "STAR" registry. The primary outcome was a 90-day modified Rankin Scale of 0 to 2. Secondary outcomes included periprocedural cerebral infarction and intracranial hemorrhage, perioperative symptomatic cerebral vasospasm in ruptured IA and mortality, and all causes of mortality within 90 days.

Results: One thousand fifty-three patients were White (37.1%), 350 were Black (12.3%), 264 were Hispanic (9.3%), and 1169 were other (41.2%). Compared with White patients, Hispanic patients had a significantly lower proportion of primary outcome (adjusted odds ratio [aOR] 0.36, 95% CI, 0.23-0.56) and higher proportion of the periprocedural cerebral infarction, perioperative mortality, and all causes of mortality (aOR 2.53, 95% CI, 1.40-4.58, aOR 1.84, 95% CI, 1.00-3.38, aOR 1.83, 95% CI, 1.06-3.17, respectively). Outcomes were not significantly different in Black and other patients. The subgroup analysis showed that Hispanic patients with age ≥65 years (aOR 0.19, 95% CI, 0.10-0.38, interaction P = .048), Hunt-Hess grades 0 to 3 (aOR 0.29, 95% CI, 0.19-0.46, interaction P = .03), and MST (aOR 0.24, 95% CI, 0.13-0.44, interaction P = .04) had a significantly low proportion of primary outcome.

Conclusion: This study demonstrates that Hispanic patients with IA are more likely to have a poor outcome at 90 days after endovascular treatment or MST than White patients. Physicians have to pay attention to the selection of treatment modalities, especially for Hispanic patients with specific factors to reduce racial discrepancies.

Abstract

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