UK carotid endarterectomy results revealed

By Piriya Mahendra, medwireNews Reporter

Round 4 of the UK Carotid Endarterectomy Audit, organized by the Royal College of Physicians, has revealed that the average delay from stroke or transient ischemic attack (TIA) symptom onset to surgery is shortening.

This finding demonstrates continued improvement in the quality of care for stroke and TIA patients, says the audit's steering committee.

David Mitchell (Spire Bristol Hospital, UK), the audit chairman remarked in a press statement: "Carotid surgery is being performed more effectively than before in the National Health Service and in doing so preventing more strokes and their associated misery."

Round 4 of the audit, which included all carotid endarterectomies performed between December 2005 and December 2007 in the UK, showed that the median delay between symptom onset and surgery was 15 days, compared with 21 days in Round 3, which surveyed October and September 2010.

In addition, there was an overall increase, from Round 3, in the proportion of patients treated within 14 days as recommended by the UK National Institute of Clinical Guidance (NICE).

However, there was considerable variation in reaching this target across regions. Indeed, London was the only region in the UK in which 71-80% of patients underwent surgery in the recommended 14 days. The committee suggests a number of reasons for this, including patient awareness and organizational structure/pathway management.

Tony Rudd (Guy's and St Thomas' Hospital, London, UK), Chair of the Intercollegiate Stroke Working Party, said: "We are making steady progress towards achieving the standards set, but there are still too many patients who are being treated too slowly with unacceptable variability around the country."

"Care should be focused on centres that are well organised and experienced in performing carotid endarterectomy surgery."

Ross Naylor (University of Leicester, UK), a member of the steering committee, said: "Britain has led the drive toward expedited surgery around the world and the latest results reflect the hard work that has gone towards achieving this for our patients."

The steering committee makes several recommendations for change including clearly documented patient pathways spanning how patients access services and how they flow through to surgery if required; and agreeing referral protocols for TIA and minor stroke to minimize delays in the pathway. They also recommend that stroke teams publicize their services to primary care and the public.

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