Outcomes of Stenting for ICAD in Hispanic Women: Focus on Strokes and Mortality

Background Intracranialatheroscleroticdisease(ICAD) isa majorcause of recurrent stroke. Previousstudieshave suggested demographicdisparitiesinoutcomes after stenting.Thisstudy evaluatedrecurrence of cerebrovascular events and mortalityby race/ethnicityand sex, witha particularfocus on Hispanicfemales. Thissubgroup was emphasizeddue to health disparities,whichareimpactedby socioeconomicbarriersand cultural factors that impactaccess to care and adherenceto medicalmanagement. Methods We analyzed 114 patients with ICAD who underwent stenting. Outcomes included transientischemicattack (TIA), stroke, and death inthe same arterialterritory. Logisticand Coxregressionanalyses were performed to assess the impact of race/ethnicityand sex. Multivariablemodels were adjustedfor age, sex, race, hypertension, diabetes, hyperlipidemia, smoking, dualantiplatelettherapy (DAPT) before stenting, affected artery, qualifying cerebrovascular event, arterial stenosis ratio, and stenosis length. Results Of 114 patients(52 White,8 AfricanAmerican,54 Hispanic;76 male, 38 female), 13 (11.4%)experiencedTIA, 13 (11.4%) had stroke, and 13 (11.4%) died.TIAs occurred most frequently inHispanics(20.4%), especiallyamong Hispanicfemales, compared withWhitefemales (3.8%, p = .016). Mortalitywas also higheramong Hispanicfemales (18.5%) compared withWhitefemales (5.8%), although not statisticallysignificant( p = .068). Stroke recurrence didnotsignificantlydiffer by ethnicityor sex. Multivariablelogisticregressiondemonstrated thatHispanicethnicitywas independentlyassociatedwithhigherodds of TIA compared withWhitepatients(OR 498.35, 95% CI 5.09–48,745.02, p = .008). Female sex was directlyassociatedwithincreasedmortality(HR 5.15, 95% CI 1.08–24.64, p = .040). Together, these findingsdemonstrate that Hispanicfemales have an elevated riskof both recurrent TIA and mortality. Conclusion Hispanicpatients—particularlyHispanicfemales—experiencea significantlyhigherriskofrecurrent TIA after ICAD stenting,and show a trend toward highermortality. Whilestrokerecurrence rates didnot have a significantdifference, the prevalence of TIA inHispanicsisclinicallyimportant,as recurrent TIA isa strong predictorof future stroke and poor long‐termoutcomes. These findingshighlightthe need for focused strategiesto improvesecondary prevention,adherence to medicalmanagement, and healthcare access inHispanicfemales, agroup whose outcomes are shaped by socioeconomicdisadvantageand cultural barriersto care.