Delayed Carotid Surgery: What Are the Causes in the North West of England?

详细信息	查看全文 | 推荐本文 |

• 作者：D. Purkayastha^a ; ^d ; S.W. Grant^b ; ^d ; J.V. Smyth^c ; ^d ; C.N. McCollum^b ; ^d ; ^{cnmcc@manchester.ac.uk}
• 关键词：Carotid stenosis ; Carotid endarterectomy ; Clinical audit
• 刊名：European Journal of Vascular and Endovascular Surgery
• 出版年：2012
• 期刊代码：122_10785884
• 类别：med
• 出版时间：June, 2012
• 卷：43
• 期：6
• 页码：637-641
• 文件大小：166 K

摘要

Introduction

Carotid endarterectomy (CEA) should be performed within two weeks of symptoms for patients with carotid stenosis >50%. Whether these standards are being achieved and causes of delay between symptoms and CEA were investigated.

Design

An analysis of prospectively collected multi-centre data.

Materials

Consecutive data for patients undergoing CEA between January-2006 and September-2010 were collected. Asymptomatic patients and those with no details on the timing of cerebral symptoms were excluded.

Methods

鈥楧elay鈥?from symptom to CEA was defined as more than two weeks and 鈥榩rolonged-delay鈥?more than eight weeks. Univariable and multivariable analyses were used to identify factors associated with these delays.

Results

Of 2147 patients with symptoms of cerebral ischaemia, 1522(70.9%) experienced 鈥榙elay鈥?and 920(42.9%) experienced 鈥榩rolonged delay鈥? Patients with ischaemic heart disease were more likely to experience 鈥榙elay鈥?(OR聽=聽1.56; 95%CI 1.11-2.19, p聽=聽0.011), whereas patients with stroke (OR聽=聽0.77; 95%CI 0.63-0.94, p聽=聽0.011) and those treated at hospitals with a stroke-prevention clinic (OR聽=聽0.57; 95%CI 0.46-0.71, p聽<聽0.001) were less likely to experience 鈥榙elay鈥? Patients treated after the publication of National Institute for Health and Clinical Excellence (NICE) guidelines were less likely to experience 鈥榩rolonged delay鈥?(OR聽=聽0.77; 95%CI 0.65-0.91, p聽=聽0.003) but not 鈥榙elay鈥?

Conclusion

Few patients achieved CEA within two weeks of symptoms. Introducing stroke-prevention clinics with one-stop carotid imaging appears important.