• 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, and STAR Registry Investigators.
• Department of Neurosurgery, Hyogo Medical University, Nishinomiya , Japan.
• Neurosurgery. 2024 Oct 1; 95 (4): 807815807-815.

Background And ObjectivesThe 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.MethodsThe 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.ResultsOne 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.ConclusionThis 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.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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