Inequalities in Access to Reperfusion in Ischemic Stroke and Their Impact on Clinical Outcomes: An Integrative Review

This integrative review examined how inequalities in access to reperfusion for ischemic stroke, through intravenous thrombolysis and mechanical thrombectomy, relate to clinical outcomes. Sixteen publications from PubMed and SciELO, published in the last five years, were included. Findings were grouped into three themes and integrated through narrative synthesis. Studies described differences in reperfusion use by race and ethnicity, socioeconomic status, rural or urban residence, treating hospital and health system. In the Brazilian studies, thrombolysis predominated over thrombectomy and the regional distribution of services was uneven. In some investigations, social position was also associated with functional outcome after treatment. Most studies were observational and conducted in the United States, which limits causal inference and the transfer of findings to Brazil. The results point to the need to strengthen stroke care networks and to monitor access by group and territory.