A strategy to meet the ‘two-week' target for carotid endarterectomy in symptomatic patients

• Published in: Clinical medicine (London, England) Vol. 11; no. 5; pp. 452 - 455
• Main Authors: Abbas, K, Vohra, RS, Salhab, M, Sinclair, MD, Kent, PJ, Gough, MJ
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.10.2011; Royal College of Physicians
• Subjects: Aged; Aged, 80 and over; Audit; Biological and medical sciences; carotid endarterectomy; Endarterectomy, Carotid; Female; General aspects; Guidelines as Topic; Humans; Male; Medical sciences; Middle Aged; Neurology; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Health Care - standards; service provision; State Medicine - standards; Stroke - prevention & control; stroke prevention; United Kingdom; Vascular diseases and vascular malformations of the nervous system; service provision; carotid endarterectomy; stroke prevention; Targeting; Cardiovascular disease; Vascular disease; Prevention; Target; Surgery; Blood vessel; Endarteriectomy; Cerebrovascular disease; Human; Nervous system diseases; Stroke; Patient; Artery; Cerebral disorder; Medicine; Symptomatology; Treatment; Carotid; Central nervous system disease; Strategy; Circulatory system
• ISSN: 1470-2118; 1473-4893
• DOI: 10.7861/clinmedicine.11-5-452

Carotid endarterectomy (CEA) within two weeks of the index neurological event (INE) achieves maximum stroke prevention. This study assesses the impact of institution-wide policy changes on CEA performance in symptomatic patients. Between two study periods (1 January 2007 and 31 December 2007; 1 August 2008 and 31 July 2009) transient ischaemic attack (TIA) clinics, an acute stroke protocol and utilisation of vascular operating lists, were adopted. Following the changes, the interval between the INE and CEA fell from 23 (n=65; interquartile range (IQR) 9–66) to 6.5 (n=52; IQR 2–13.5) days (p<0.001) with 32.3% ν 82.7% performed within two weeks (p<0.001). Significant improvements were seen in the time taken from onset of symptoms to presentation, and presentation to a carotid duplex and surgical review. Univariate analyses suggest this improvement is associated with the type of INE, point of presentation and the need for further imaging. Implementation of these policies has produced a significant improvement in service provision largely meeting the two-week target.