RT Journal Article
SR Electronic
T1 A strategy to meet the ‘two-week’ target for carotid endarterectomy in symptomatic patients
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 452
OP 455
DO 10.7861/clinmedicine.11-5-452
VO 11
IS 5
A1 K Abbas
A1 RS Vohra
A1 M Salhab
A1 MD Sinclair
A1 PJ Kent
A1 MJ Gough
YR 2011
UL http://www.rcpjournals.org/content/11/5/452.abstract
AB 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.