Timeliness and outcomes of carotid endarterectomy for symptomatic carotid artery stenosis: a single centre audit

Abstract

Background For patients presenting with symptomatic internal carotid artery stenosis, carotid endarterectomy (CEA) surgery is recommended to be performed generally within a 48‐hr to 14‐day window. This study aimed to assess timeliness of delivery, and outcomes, of CEA surgery in a tertiary vascular centre. Method Patients with symptomatic internal carotid artery stenosis who underwent CEA between 1 June 2014 and 31 June 2017 were identified and data were obtained from hospital records. The timeline of their journey from presentation to surgery was then mapped together with their outcomes. Results One hundred and seventy‐two cases were included in the study. Overall, the median time from development of presenting symptoms to surgery was 9 days and 119 (69%) cases were operated on within 14 days. The median time from development of presenting symptoms to ultrasound imaging was 2 days and the median time from symptoms to vascular referral was also 2 days. There were no deaths, strokes or transient ischaemic attacks within 30 days of CEA. At 1 year, survival was 100% but 15 (8.7%) had experienced at least one transient ischaemic attack or stroke. In the 53 cases operated upon beyond 14 days the dominant cause of delay in 32 (60%) was accessing surgery after review by the vascular service. Conclusion The aim of delivering CEA within 14 days of developing relevant symptoms was achieved in most cases with good outcomes. Nevertheless, points of delay in the patient journey that could be targeted for future quality improvement were identified.

Frequency of inter-specialty consensus decisions and adherence to advice following discussion at a weekly neurovascular multidisciplinary meeting

“…Between 2005 and 2013, many vascular surgeons transitioned to performing most CEAs within 2 weeks of symptom onset, with the mean time to surgery decreasing from 25 to 6 days [ 25 ]. The median interval from index symptoms to revascularisation in our 50–99% SCS patients of 12.5 days is in keeping with recent international clinical practice guidelines which recommended that CEA be performed preferably within 2 weeks of symptom onset [ 2 – 6 , 25 – 28 ]. The median interval from MDM to revascularisation in patients with 50–99% SCS was 5.5 days, partly due to the fact that our vascular surgeons do not have routine access to ‘protected emergency theatre slots’ for patients warranting urgent carotid endarterectomy outside of their scheduled vascular surgery lists.…”

Safety of Carotid Endarterectomy for Symptomatic Stenosis by Age: Meta-Analysis With Individual Patient Data

“…Forty-seven studies, comprising 107 587 patients and 23 188 octogenarians, met the inclusion criteria: 7 prospective cohort studies, 25 retrospective cohort studies, 6 registries, and 7 randomized controlled trials. 1,6,7,12,18–58 Most of the cohorts were from North America (n=16), Europe (n=11), with 3 from Asia, 1 from Australia, and 1 from New Zealand. The year of publication, demographic details, study design, and surgical methods are summarized in Table S2.…”

Effectiveness of carotid council in the treatment of carotid artery disease: Early-term outcomes of the multidisciplinary approach

“…13 CEA should be performed as soon as possible after stabilization of the neurological event. 13 Carotid stenting is risky in the earlier period of the neurological events. 9 In our multidisciplinary approach, we perform CEA as soon as possible; however, in patients with minimal brain infarct, we delay the procedure for 48 h.…”

“…10 Currently, it was reported that the benefit of CEA is increases with earlier intervention. 13 CEA should be performed as soon as possible after stabilization of the neurological event. 13 Carotid stenting is risky in the earlier period of the neurological events.…”