Time to carotid stenosis treatment ‘can be shortened’

By Piriya Mahendra, MedWire Reporter

Researchers say it is possible to surgically treat carotid stenosis patients within 2 weeks of their index symptom.

Katariina Noronen (Helsinki University Hospital, Finland) and team acknowledge that while the desired time of 2 weeks between carotid stenosis symptom identification and treatment with carotid endarterectomy (CEA) was rarely reached in their study, this goal is attainable if patients are referred emergently.

In 2009, clinicians at Helsinki University Hospital implemented a CEA management intervention whereby computed tomography angiograms were requested on an emergency basis and 2-weekly time slots were added to the operating schedule, in an effort to reduce the delay between symptom recognition and treatment.

They found that the median time from index symptom to surgery was 19 days, and ranged from 1 to 236 days.

However, of 144 operations only 53 (37%) of CEA patients were operated on within 2 weeks, note the authors in the European Journal of Vascular and Endovascular Surgery.

Analysis revealed that 45 of these patients came to the hospital on an emergency basis and 17 (32%) were performed on-call.

The median time to operation for the on-call patients was just 13 days compared with 36 days for those who were referred electively.

Of the 21 patients who had a surgical delay exceeding 12 weeks, only four (19%) had an emergency referral to a neurologist. Compared with patients whose delay was less than 12 weeks, these patients were more likely to be female, have an index symptom of amaurosis fugax, and were significantly less likely to have a stroke (19 vs 41%).

Of note, the authors found that patient-related delay, defined as time taken to see a doctor after an index symptom arises, accounted for a median 43 days of the total symptom-treatment time in patients with a delay of more than 12 weeks.

"Therefore, getting the patients on an emergency basis to hospital and providing the required care is definitely a goal worth aiming at," says the team.

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