Waiting times for carotid endarterectomy in UK: observational study

Abstract

Results 240 (61% of those eligible) consultant surgeons took part from 102 (76%) hospitals and trusts. Of 9913 carotid endarterectomies recorded on hospital episode statistics, 5513 (56%) were included. Of the patients who underwent endarterectomy, 83% had a history of transient ischaemic attack or stroke. Of these recently symptomatic patients, 20% had their operation within two weeks of onset of symptoms and 30% waited more than 12 weeks. Operative mortality was 0.5% during the inpatient stay and 1.0% (95% confidence interval 0.7% to 1.3%) by 30 days. Conclusion Only 20% of symptomatic patients had surgery within the two week target time set by the National Institute for Health and Clinical Excellence (NICE). Although operative mortality rates are comparable with those in other countries, some patients might experience disabling or fatal stroke while waiting for surgery and hence not be included in operative statistics. Major improvements in services are necessary to enable early surgery in appropriate patients in order to prevent strokes.

Costs of Secondary Prevention of Stroke by Carotid Endarterectomy

“…In Denmark 6 CEAs were performed per 100,000 inhabitants in 2007 compared to 5 per 100,000 inhabitants in our population, and time from onset of symptoms to operation was a median of 47 days in Denmark in 2007 compared to 38 days in this study. Moreover, waiting time from onset of symptoms to operation in our population is within the range of waiting time reported in other studies [14,15,16]. …”

Amaurosis fugax: risk factors and prevalence of significant carotid stenosis

“…Carotid disease is one of the major causes of stroke in the world, and stroke itself is one of the most common causes of mortality and severe disability in adults 6. Giant cell arteritis (GCA) is another cause of AF, and it is hence important to analyze inflammatory parameters such as sedimentation rate (SR) and C-reactive protein (CRP) to minimize the risk of permanent visual loss 3…”

Amaurosis fugax – delay between symptoms and surgery by specialty

“…This is the most effective stroke prevention in symptomatic patients 7. The current recommendation is that the patient should be operated within 2 weeks from the debut of symptoms or even within 48 hours if being neurologically stable 6,8. However, a recent study shows that the risk of early recurrent stroke in symptomatic carotid stenosis is not as high as was previously feared and data from the Swedish Vascular Registry demonstrate an increased risk of perioperative complications in patients treated surgically within 0–2 days 9,10.…”