Women with severe stroke less likely than men to be sent to level 1 stroke centers

Women may be less likely than men to get timely care for emergent large vessel occlusion (ELVO) ischemic strokes, according to a study presented today at the Society of NeuroInterventional Surgery's (SNIS) 18th Annual Meeting. An ELVO—the deadliest type of stroke—is caused by a clot that is blocking a large vessel and cutting off significant blood flow to the brain.

The study, "Women with Large Vessel Occlusion Acute Ischemic Stroke Are Less Likely to Be Routed to Comprehensive Stroke Centers," reviewed 1.5 years of data from 10 stroke centers to see which patients experiencing an ELVO were routed directly to comprehensive (or Level 1) stroke centers to receive neuroendovascular stroke surgery (or thrombectomy). These are minimally invasive procedures that use catheters to reopen blocked arteries in the brain.

Like Level 1 trauma centers, Level 1 stroke centers have the most comprehensive services, including a specially trained neurointerventional care team that is available to treat strokes 24/7/365. By contrast, primary stroke centers may not have round the clock stroke surgery capability, may not have a specialized intensive care unit for stroke patients, and may need to transfer the most complex patients to Level 1 stroke centers.

Of 490 patients suffering from ELVO included in this study, women made up nearly half (46%) of the total. Stroke severity, travel distances to Level 1 stroke centers and comorbidities were similar between women and men, although women were older (median of 73 vs. 65 years of age). Whereas nearly 90% of male patients with ELVO were routed directly to Level 1 stroke centers, significantly lower rates were observed in women. After taking into account differences in stroke type, age, travel distance and other relevant factors, women with ELVO were approximately 11% less likely to be taken to a Level 1 stroke center compared to men.

"It's essential that all patients with emergent large vessel occlusion ischemic strokes receive urgent care for this condition in the most appropriate setting," said Sunil Sheth, MD, lead author on the study and assistant professor of neurology at McGovern Medical School at The University of Texas Health Science Center at Houston. "At state and regional levels around the nation, we have built pre-hospital routing programs to ensure that patients with this type of stroke are taken directly to the appropriate hospitals. This study shows that we need to work harder to bridge the gender health care gap and ensure that all patients who need stroke surgery are routed to the right hospital for the best chance of survival, recovery and independence."