Vascular Governance North West, 1st Floor Education and Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester, England, United Kingdom.
Eur J Vasc Endovasc Surg. 2012 Jun;43(6):637-41. doi: 10.1016/j.ejvs.2012.03.016. Epub 2012 Apr 15.
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.
An analysis of prospectively collected multi-centre data.
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.
'Delay' from symptom to CEA was defined as more than two weeks and 'prolonged-delay' more than eight weeks. Univariable and multivariable analyses were used to identify factors associated with these delays.
Of 2147 patients with symptoms of cerebral ischaemia, 1522(70.9%) experienced 'delay' and 920(42.9%) experienced 'prolonged delay'. Patients with ischaemic heart disease were more likely to experience 'delay' (OR = 1.56; 95% CI 1.11-2.19, p = 0.011), whereas patients with stroke (OR = 0.77; 95%CI 0.63-0.94, p = 0.011) and those treated at hospitals with a stroke-prevention clinic (OR = 0.57; 95%CI 0.46-0.71, p < 0.001) were less likely to experience 'delay'. Patients treated after the publication of National Institute for Health and Clinical Excellence (NICE) guidelines were less likely to experience 'prolonged delay' (OR = 0.77; 95%CI 0.65-0.91, p = 0.003) but not 'delay'.
Few patients achieved CEA within two weeks of symptoms. Introducing stroke-prevention clinics with one-stop carotid imaging appears important.
对于颈动脉狭窄>50%的患者，应在症状出现后两周内进行颈动脉内膜切除术（CEA）。本研究旨在调查这些标准是否得到了执行，以及症状与 CEA 之间发生延迟的原因。
前瞻性收集多中心数据的分析。
收集 2006 年 1 月至 2010 年 9 月期间接受 CEA 的连续患者数据。排除无症状患者和无脑部症状发生时间详细信息的患者。
将症状与 CEA 之间的“延迟”定义为超过两周，“长时间延迟”超过八周。采用单变量和多变量分析来确定与这些延迟相关的因素。
在 2147 名有脑缺血症状的患者中，1522 名（70.9%）经历了“延迟”，920 名（42.9%）经历了“长时间延迟”。患有缺血性心脏病的患者更有可能经历“延迟”（OR=1.56；95%CI 1.11-2.19，p=0.011），而患有中风（OR=0.77；95%CI 0.63-0.94，p=0.011）和在设有中风预防诊所的医院接受治疗的患者（OR=0.57；95%CI 0.46-0.71，p<0.001）不太可能经历“延迟”。在国家卫生与临床优化研究所（NICE）指南发布后接受治疗的患者不太可能经历“长时间延迟”（OR=0.77；95%CI 0.65-0.91，p=0.003），但不会经历“延迟”。
很少有患者在症状出现后两周内接受 CEA。引入具有一站式颈动脉成像的中风预防诊所似乎很重要。
