Introduction: The complexity of neurointervention for stroke limits the number of hospitals that are able to provide this therapy. Our aim was to examine the availability of endovascular treatment across boroughs in New York City for a single hospital network.
Methods: We performed a retrospective analysis on 92 stroke patients who presented to a hospital in New York City and ultimately received endovascular treatment for acute stroke at four hospitals in Manhattan. A subanalysis was performed on 39 patients from Queens and on 36 patients from Manhattan. Mean income of the zip code each patient is from, last-known-well, groin puncture time, recanalization time, baseline NIHSS, and discharge NIHSS were collected.
Results: Onset-to-recanalization times were significantly different between the five boroughs of New York City (P=0.0062). 42% of patients were from Queens and 39% were from Manhattan. The mean income of the zip code patients were from was $63,608.70 for Queens and $98,446.59 for Manhattan (P=0.0014). Mean onset-to-recanalization time was 352 minutes for patients from Queens and 275 minutes for patients from Manhattan (P=0.0009). Similarly, onset-to-puncture time was 301 minutes for patients from Queens and 222 minutes for patients from Manhattan (P=0.0011). Change in NIHSS from admission to discharge was -2.5 for Queens patients and -5.4 for Manhattan patients, but this difference was not statistically significant (P=0.4292).
Conclusions: Our findings suggest that patients in Queens have less access to endovascular stroke treatment than patients in Manhattan as seen in longer onset-to-recanalization and onset-to-puncture times. Even within dense, urban environments with extensive hospital networks such as New York City, there are significant disparities in access to endovascular stroke treatment.
Patient Care: This research identifies differences in access to endovascular care across boroughs of New York and suggests that disparities in access to neurointervention even in dense, urban environments.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of determining access to endovascular care, 2) Discuss, in small groups, differences between Manhattan and Queens with respect to access to endovascular care