Decreasing the Delay to Carotid Endarterectomy in Symptomatic Patients with Carotid Stenosis – Outcome of an Intervention

Noronen, Katariina; Vikatmaa, Pirkka; Sairanen, Tiina; Lepäntalo, Mauri; Venermo, Maarit

doi:10.1016/j.ejvs.2012.06.014

Cited by 13 publications

(17 citation statements)

References 18 publications

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“…The impact of the Danish National Indicator Project, launched in 2008, has been investigated in a Danish nationwide survey which showed that from 2007 to 2010, the percentage of patients with stroke and ICA stenosis who underwent CEA within 2 weeks increased from 13% to 47% (Witt et al ., ). In the years before this study, our vascular department (Rathenborg et al ., ) and others (Noronen et al ., ) reduced the time from referral to surgery by introducing an accelerated course of examinations – a so‐called fast track.…”

Section: Discussionmentioning

confidence: 99%

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Screening with doppler ultrasound for carotid artery stenosis in patients with stroke or transient ischaemic attack

Kristensen

Hovind

Iversen

et al. 2017

Clin Physio Funct Imaging

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show abstract

Section: Discussionmentioning

confidence: 99%

“…National surveys and reports from stroke centres in other countries show that the 14-day time limit is far from being met in all patients (Brown & Naylor, 2009;Vikatmaa et al, 2011;Jetty et al, 2012;Noronen et al, 2012;Purkayastha et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Screening with doppler ultrasound for carotid artery stenosis in patients with stroke or transient ischaemic attack

Kristensen

Hovind

Iversen

et al. 2017

Clin Physio Funct Imaging

View full text Add to dashboard Cite

show abstract

“…This was mostly as a result of the lack of patient awareness in seeking urgent medical advice, but delay in the diagnostics still occur. 28,31 The two week recommendation is obtained from post-hoc analysis and has not been evaluated in RCTs.…”

Section: Delay and Sexmentioning

confidence: 99%

The Efficacy of Carotid Surgery by Subgroups: The Concept of Stroke Prevention Potential

Aro

Ijäs

Vikatmaa

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Patient selection should be a key component of carotid surgery reports. A calculator was created where the presence and recentness of symptoms, sex, increasing stenosis severity, and complication rates could all be combined into a single figure. The calculator was tested on real life material and some theoretical inclusion scenarios. Single hospital treatment development over time and benchmarking between hospitals can be monitored when registered data includes these parameters, ultimately leading to improved patient selection.Objective: Considering carotid endarterectomy (CEA), reporting treatment delay, symptom status, and surgical complication rates separately gives an incomplete picture of efficacy; therefore, the aim was to combine these factors and develop a reporting standard that better describes the number of potentially prevented strokes. With a real life cohort and theoretical inclusion scenarios, the aim was to explore the stroke prevention potential of different carotid practices. Methods: Landmark studies for symptomatic and asymptomatic patients were revisited. By using published estimates of treatment effect, a simplified calculator was designed to assess the five year stroke prevention rate per 1000 CEAs (stroke prevention potential [SPP], range 0e478), including the presence and recentness of symptoms, sex, increasing stenosis severity, and complication rates. Patients operated on for carotid stenosis at Helsinki University Hospital (HUH) between 2008 and 2016 were collected from a vascular registry (HUSVASC) and categorised according to the model. The local annual complication rate was re-evaluated and added to the model. The HUH patient cohort was incorporated into the SPP model, and changes over time analysed. Finally, theoretical changes in patient selection were compared in order to explore the theoretical impact of patient selection and shortening of the delay. Results: Fifteen hundred and five symptomatic and 356 asymptomatic carotid stenoses were operated on with stroke plus death rates of 3.6% and 0.3%, respectively. The proportion of CEAs performed within two weeks of the index event increased over the follow up period, being 77% in 2016. The SPP increased from 123 in 2008 to 229 in 2016. Theoretically, 350 ischaemic strokes were prevented in the period 2008e16, with 1861 CEAs. Conclusions: National and international comparison of different CEA series is irrelevant if the inclusion criteria are not considered. A calculator that is easy to apply to large scale high quality registered data was developed and tested. SPP was found to increase over time, which is a probable sign of improved patient selection and an increased number of strokes prevented by the CEAs performed.

show abstract

Section: Delay and Sexmentioning

confidence: 99%

The Efficacy of Carotid Surgery by Subgroups: The Concept of Stroke Prevention Potential

Aro¹,

Ijäs²,

Vikatmaa³

et al. 2019

Journal of Vascular Surgery

Self Cite

View full text Add to dashboard Cite

WHAT THIS PAPER ADDS Patient selection should be a key component of carotid surgery reports. A calculator was created where the presence and recentness of symptoms, sex, increasing stenosis severity, and complication rates could all be combined into a single figure. The calculator was tested on real life material and some theoretical inclusion scenarios. Single hospital treatment development over time and benchmarking between hospitals can be monitored when registered data includes these parameters, ultimately leading to improved patient selection. Objective: Considering carotid endarterectomy (CEA), reporting treatment delay, symptom status, and surgical complication rates separately gives an incomplete picture of efficacy; therefore, the aim was to combine these factors and develop a reporting standard that better describes the number of potentially prevented strokes. With a real life cohort and theoretical inclusion scenarios, the aim was to explore the stroke prevention potential of different carotid practices. Methods: Landmark studies for symptomatic and asymptomatic patients were revisited. By using published estimates of treatment effect, a simplified calculator was designed to assess the five year stroke prevention rate per 1000 CEAs (stroke prevention potential [SPP], range 0e478), including the presence and recentness of symptoms, sex, increasing stenosis severity, and complication rates. Patients operated on for carotid stenosis at Helsinki University Hospital (HUH) between 2008 and 2016 were collected from a vascular registry (HUSVASC) and categorised according to the model. The local annual complication rate was re-evaluated and added to the model. The HUH patient cohort was incorporated into the SPP model, and changes over time analysed. Finally, theoretical changes in patient selection were compared in order to explore the theoretical impact of patient selection and shortening of the delay. Results: Fifteen hundred and five symptomatic and 356 asymptomatic carotid stenoses were operated on with stroke plus death rates of 3.6% and 0.3%, respectively. The proportion of CEAs performed within two weeks of the index event increased over the follow up period, being 77% in 2016. The SPP increased from 123 in 2008 to 229 in 2016. Theoretically, 350 ischaemic strokes were prevented in the period 2008e16, with 1861 CEAs. Conclusions: National and international comparison of different CEA series is irrelevant if the inclusion criteria are not considered. A calculator that is easy to apply to large scale high quality registered data was developed and tested. SPP was found to increase over time, which is a probable sign of improved patient selection and an increased number of strokes prevented by the CEAs performed.

show abstract

Decreasing the Delay to Carotid Endarterectomy in Symptomatic Patients with Carotid Stenosis – Outcome of an Intervention

Cited by 13 publications

References 18 publications

Screening with doppler ultrasound for carotid artery stenosis in patients with stroke or transient ischaemic attack

Screening with doppler ultrasound for carotid artery stenosis in patients with stroke or transient ischaemic attack

The Efficacy of Carotid Surgery by Subgroups: The Concept of Stroke Prevention Potential

The Efficacy of Carotid Surgery by Subgroups: The Concept of Stroke Prevention Potential

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