The greatest benefits of carotid endarterectomy (CEA) accrue when performed within two weeks of acute ischaemic stroke (AIS) due to symptomatic carotid stenosis. Previous studies have identified multiple factors contributing to CEA delay.
To determine factors associated with delayed CEA in patients admitted to tertiary stroke centres within a major metropolitan region with AIS
In a retrospective cohort study, consecutive patients admitted to the tertiary hospitals with stroke units within South Australia (Lyell McEwin Hospital, Royal Adelaide Hospital and Flinders Medical Centre) between 2016 to 2020 were included. Univariable and multivariable logistic regression were used to identify individual factors associated with time from symptom onset to CEA of over two weeks.
A total of 174 patients were included. The median time to CEA was 5 days (IQR 3-9.75). Delayed CEA beyond 14 days occurred in 28/174 (16%). Factors most associated with delayed CEA included presentation to a tertiary hospital without onsite Vascular Surgical Unit (OR 3.71, 95%CI 1.31-10.58), history of previous stroke (OR 3.38, 95% CI 1.11-9.84) and presenting NIHSS above 6 (OR 5.16, 95% CI 1.60-16.39).
This study identified that presentation to a tertiary hospital without a Vascular Surgery Unit, history of previous stroke and presenting NIHSS above 6 were associated with delay to CEA in AIS patients in South Australia. Interventional studies aiming to improve the proportion of patients that receive CEA within 14 days are required.
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ABS. 2018 Survey of disability, ageing and carers, customised data report. 2019.
- A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project–1981-86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage.J Neurol Neurosurg Psychiatry. 1990; 53: 16-22
- Clinical and instrumental evaluation of patients with ischemic stroke within the first six hours.J Neurol Sci. 1989; 91: 311-321
- Risk of recurrent stroke before carotid endarterectomy: the ANSYSCAP study.Int J Stroke. 2013; 8: 220-227
- 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS).Eur Heart J. 2018; 39: 763-816
- Carotid endarterectomy within seven days after the neurological index event is safe and effective in stroke prevention.Eur J Vasc Endovasc Surg. 2011; 42: 732-739
- Reducing delay of carotid endarterectomy in acute ischemic stroke patients.Stroke. 2013; 44: 686-690
- Factors associated with hospital dependent delay to carotid endarterectomy in the Dutch audit for carotid interventions.Eur J Vasc Endovasc Surg. 2019; 58: 495-501
- Factors associated with delay in carotid endarterectomy for patients with symptomatic severe internal carotid artery stenosis: a case–control study.Can Med Assoc Open Access J. 2018; 6: E211-E217
- Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med. 1991; 325: 445-453
- Australian Clinical Guidelines for Acute Stroke Management 2007. Acute stroke guidelines writing subgroup on behalf of the national stroke foundation clinical guidelines for acute stroke management expert working group.Int J Stroke. 2008; 3: 120-129
- Editor's choice – management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS).Eur J Vasc Endovasc Surg. 2018; 55: 3-81
- American society of anesthesiology and Rankin as predictive parameters for the outcome of carotid endarterectomy within 28 days after an ischemic stroke.J Stroke Cerebrovasc Dis. 2006; 15: 114-120
- Patients with moderate to severe strokes (NIHSS score >10) undergoing urgent carotid interventions within 48 hours have worse functional outcomes.J Vasc Surg. 2019; 69: 1471-1481
Published online: December 22, 2022
Accepted: November 27, 2022
Received: September 19, 2022
☆Sources of support:
☆This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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