Abstract
Background
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.
Aims
To determine factors associated with delayed CEA in patients admitted to tertiary
stroke centres within a major metropolitan region with AIS
Methods
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.
Results
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).
Conclusion
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.
Keywords
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References
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
Article info
Publication history
Published online: December 22, 2022
Accepted:
November 27,
2022
Received:
September 19,
2022
Footnotes
☆Sources of support:
☆This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106916
Copyright
© 2022 Elsevier Inc. All rights reserved.
